Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation‐based Study

Abstract

This study demonstrated variable adherence to pediatric cardiac arrest guidelines across a spectrum of EDs. Overall adherence was not associated with ED pediatric volume. Medium-high-volume EDs demonstrated the highest levels of adherence for BLS and PEA. Lower-volume EDs were noted to have lower adherence to BLS guidelines. Improved adherence was not directly associated with higher PRS score provider experience, simulation teamwork performance, or more providers with PALS training. This study demonstrates that current approaches optimizing the care of children in cardiac arrest in the ED (provider training, teamwork training, environmental preparation) are insufficient.

A Modified Delphi Study to Prioritize Content for a Simulation‐based Pediatric Curriculum for Emergency Medicine Residency Training Programs

“…1,4,5 These lower-volume EDs are less likely to comply with evidence-based treatment guidelines for high-acuity conditions. [6][7][8][9][10] These studies may represent opportunities to improve the existing pediatric training of EM residents and attending physicians.…”

“…Higher mortality rates for pediatric cardiac and respiratory arrest have been reported in EDs with lower annual pediatric patient visits 1,4,5 . These lower‐volume EDs are less likely to comply with evidence‐based treatment guidelines for high‐acuity conditions 6‐10 . These studies may represent opportunities to improve the existing pediatric training of EM residents and attending physicians.…”

Executive Summary: The 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps

“…There is variability in access to EDs in general, and access to “pediatric‐ready” EDs remains a challenge in many regions of the United States . Substantial variability exists in adherence to pediatric cardiac arrest and sepsis guidelines across EDs. The distribution of fellowship‐trained pediatric emergency physicians continues to be uneven, with a relative abundance of board‐certified pediatric emergency physicians in some urban areas, many regions with far fewer pediatric emergency physicians and five states with none at all .…”

Community-based in situ simulation: bringing simulation to the masses

“…Distributed simulation was initially introduced through Kneebone’s description of a transportable mobile operating room environment. This approach has been elaborated on by additional reports describing simulation-adapted recreational vehicles and lower cost mobile simulation centers [10, 13–16, 39–43].…”