Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality in the United States. Comprehensive hemorrhage protocols have been shown to improve outcomes related to postpartum hemorrhage, and a critical component in these processes include communication, teamwork, and team-based practice/simulation. As medicine becomes increasingly complex, the ability to practice in a safe setting is ever more critical, especially for low-volume, high-stakes events such as postpartum hemorrhage. These events require well-functioning teams and systems coupled with rapid assessment and appropriate clinical action to ensure best patient outcomes. We have shown that a multidisciplinary in situ simulation exercise improves self-reported comfort with managing obstetric emergencies, and is a safe and effective way to practice skills and improve systems processes in the health care setting.

Objectives In effort to improve chest compression quality among health care providers, numerous feedback devices have been developed. Few studies, however, have focused on the use of cardiopulmonary resuscitation feedback devices for infants and children. This study evaluated the quality of chest compressions with standard team-leader coaching, a metronome (MetroTimer by ONYX Apps), and visual feedback (SkillGuide Cardiopulmonary Feedback Device) during simulated infant cardiopulmonary resuscitation. Methods Seventy voluntary health care providers who had recently completed Pediatric Advanced Life Support or Basic Life Support courses were randomized to perform simulated infant cardiopulmonary resuscitation into 1 of 3 groups: team-leader coaching alone (control), coaching plus metronome, or coaching plus SkillGuide for 2 minutes continuously. Rate, depth, and frequency of complete recoil during cardiopulmonary resuscitation were recorded by the Laerdal SimPad device for each participant. American Heart Association–approved compression techniques were randomized to either 2-finger or encircling thumbs. Results The metronome was associated with more ideal compression rate than visual feedback or coaching alone (104/min vs 112/min and 113/min; P = 0.003, 0.019). Visual feedback was associated with more ideal depth than auditory (41 mm vs 38.9; P = 0.03). There were no significant differences in complete recoil between groups. Secondary outcomes of compression technique revealed a difference of 1 mm. Subgroup analysis of male versus female showed no difference in mean number of compressions (221.76 vs 219.79; P = 0.72), mean compression depth (40.47 vs 39.25; P = 0.09), or rate of complete release (70.27% vs 64.96%; P = 0.54). Conclusions In the adult literature, feedback devices often show an increase in quality of chest compressions. Although more studies are needed, this study did not demonstrate a clinically significant improvement in chest compressions with the addition of a metronome or visual feedback device, no clinically significant difference in Pediatric Advanced Life Support–approved compression technique, and no difference between compression quality between genders.

Using RFID to confirm the placement of ER-REBOA is feasible with specificity highest in zone I. Future work should focus on refining this technology for the forward-deployed setting.

IntroductionEmergency Medicine (EM) is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME) during residency. Training and practicing key elements of DME using standardized patients (SP) may enhance preparedness among EM residents in performing this crucial skill in a clinical setting.MethodsThis training was developed to improve resident preparedness in DME in the clinical setting. Objectives included the following: the residents will be able to define a medical error; discuss ethical and professional standards of DME; recognize common barriers to DME; describe key elements in effective DME to patients and families; and apply key elements during a SP encounter. The four-hour course included didactic and experiential learning methods, and was created collaboratively by core EM faculty and subject matter experts in conflict resolution and healthcare simulation. Educational media included lecture, video exemplars of DME communication with discussion, small group case-study discussion, and SP encounters. We administered a survey assessing for preparedness in DME pre-and post-training. A critical action checklist was administered to assess individual performance of key elements of DME during the evaluated SP case. A total of 15 postgraduate-year 1 and 2 EM residents completed the training.ResultsAfter the course, residents reported increased comfort with and preparedness in performing several key elements in DME. They were able to demonstrate these elements in a simulated setting using SP. Residents valued the training, rating the didactic, SP sessions, and overall educational experience very high.ConclusionExperiential learning using SP is effective in improving resident knowledge of and preparedness in performing medical error disclosure. This educational module can be adapted to other clinical learning environments through creation of specialty-specific scenarios.

The death of a child is devastating. Although death is a part of every life, a child dying seems out of order in current times and in the context of Western Healthcare. Health professionals (HP) caring for dying children frequently report suffering. In the past four decades, HP have been concerned with providing a "good death" for patients at the end-of-life (EOL). While studies have shown what a good death includes in elderly patients in various settings, few studies have examined what constitutes a good death for pediatric patients within the hospital setting. No studies were found examining healthcare workers in all care areas within a children's hospital in the context of a specific death event. This qualitative study applied an interpretive phenomenological approach which is ideal in studying this topic because the researcher is attempting to interpret the meaning of the phenomena-namely HP lived experiences of good and bad deaths in the pediatric hospital setting, self-care needs being met subsequent to a pediatric hospital death and ongoing distress after caring for a dying child in the pediatric hospital. Health professionals working in an urban children's hospital in Southern California provided this data. Pre collected, open-ended text entries were analyzed from over 300 surveys. Directed content analysis was performed utilizing the method described by Hsieh and Shannon (2005). Analysis of good and bad death data was directed by empirical domains of the Quality of Dying and Death instrument proposed by Downey et al. (2010). Themes were categorized under four domains: symptom control, preparedness, connectedness, and transcendence. Several subthemes were nested under each domain. Data related to meeting the needs of HP fell under the themes: focus on patient and family, resources, and cohesion. Emerging themes related to HP report of ongoing distress were: bad death, external factors, and internal factors. Implications for future research as a result of this study include: exploration of sudden pediatric death events, exploration of the concepts, parents letting go, and everything done, and the subjective nature of a good death among HP.