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Updated: Jun 30, 2026
09:52
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
PEAK-II Trach: A Multi-Institutional Quality Improvement/Simulation Study Assessing Pediatric Emergency Readiness
Olivia Dunne1, Amanda Shen1, Roxanna Mosavian1
1Albert Einstein College of Medicine, Bronx, New York, USA.
Summary
Pediatric tracheostomy emergencies require rapid team response. In situ simulations identified system weaknesses and team performance variations impacting emergency preparedness, guiding targeted improvements.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Simulation
- Patient Safety
Background:
- Pediatric tracheostomy emergencies are critical events demanding swift, coordinated care.
- Assessing team performance and system factors is crucial for optimizing emergency response.
Purpose of the Study:
- To evaluate objective team performance during pediatric tracheostomy emergencies using in situ simulation.
- To identify latent safety threats (LSTs) and resilience supports influencing emergency readiness across various clinical settings.
Main Methods:
- Conducted in situ simulations of pediatric tracheostomy emergencies in 11 hospitals.
- Utilized NeoCHART+™ for recording critical action times and structured debriefs for LST identification.
- Employed multivariable Cox models to analyze predictors of timely critical actions.
Main Results:
- 77% of teams successfully replaced tracheostomy tubes within 5 minutes.
- Common LSTs included ventilation issues, unclear leadership, and equipment non-standardization.
- Respiratory therapists and dedicated tracheostomy teams improved critical action times.
Conclusions:
- In situ simulation effectively identified system-level LSTs, resilience factors, and performance variability in pediatric tracheostomy emergencies.
- Findings can inform targeted interventions to enhance pediatric tracheostomy emergency preparedness.
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