Disparities in Adherence to Pediatric Sepsis Guidelines across a Spectrum of Emergency Departments: A Multicenter, Cross-Sectional Observational In Situ Simulation Study

Kessler, David; Walsh, Barbara; Whitfill, Travis; Gangadharan, Sandeep; Gawel, Marcie; Brown, Linda; Auerbach, Marc

doi:10.1016/j.jemermed.2015.08.004

Cited by 77 publications

(58 citation statements)

References 63 publications

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“…[3][4][5][6][7][8] Simulation training can also be used as a tool to identify latent errors within hospital systems and as part of a participant or team assessment process. [9][10][11][12][13][14][15] The majority of simulations occur either in a purpose built centre or in the real clinical environment (in situ). A recent paper by Couto et al 16 summarises the differences between the two environments and these are described in Table 1.…”

Section: Introductionmentioning

confidence: 99%

Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre‐based, high fidelity scenarios

O’Leary

Pegiazoglou

McGarvey

et al. 2017

Emerg Medicine Australasia

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Objective: To measure scenario participant and faculty self-reported realism, engagement and learning for the low fidelity, in situ simulations and compare this to high fidelity, centre-based simulations. Methods: A prospective survey of scenario participants and faculty completing in situ and centre-based paediatric simulations.Results: There were 382 responses, 276 from scenario participants and 106 from faculty with 241 responses from in situ and 141 from centre-based simulations. Scenario participant responses showed significantly higher ratings for the centre-based simulations for respiratory rate (P = 0.007), pulse (P = 0.036), breath sounds (P = 0.002), heart sounds (P < 0.001) and patient noises (P < 0.001). There was a significant difference in overall rating of the scenario reality by scenario participants in favour of the centre-based simulations (P = 0.005); however, there was no significant difference when rating participant engagement (P = 0.11) and participant learning (P = 0.77). With the centre-based scenarios, nurses rated the reality of the respiratory rate (P < 0.001), blood pressure (P = 0.016) and abdominal signs (P = 0.003) significantly higher than doctors. Nurses rated the overall reality higher than doctors for the centre simulations (96.8% vs 84.2% rated as realistic, P = 0.041), which was not demonstrated in the in situ scenarios (76.2% vs 73.5%, P = 0.65). Conclusion: Some aspects of in situ simulations may be less 'real' than centre-based simulations, but there was no significant difference in selfreported engagement or learning by scenario participants. Low fidelity, in situ simulation provides adequate realism for engagement and learning.

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Section: Introductionmentioning

confidence: 99%

Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre‐based, high fidelity scenarios

O’Leary

Pegiazoglou

McGarvey

et al. 2017

Emerg Medicine Australasia

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“…Two Canadian studies have shown that the use of a preprinted, dedicated order sheet is associated with a decrease in the risk of error in critical care provision 19,20. Secondly, there is a role for simulation-based education and outreach to help prepare providers for high acuity, relatively infrequent events 21,22. Simulation likely plays an important role in such training, not only for the acquisition of medical skills and knowledge, but also for learning teamwork and communication strategies that may help prevent errors from occurring.…”

Section: Hypothetical Case For Discussionmentioning

confidence: 99%

High stakes and high emotions: providing safe care in Canadian emergency departments

Ali

Thomson

Graham³

et al. 2017

OAEM

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BackgroundThe high-paced, unpredictable environment of the emergency department (ED) contributes to errors in patient safety. The ED setting becomes even more challenging when dealing with critically ill patients, particularly with children, where variations in size, weight, and form present practical difficulties in many aspects of care. In this commentary, we will explore the impact of the health care providers’ emotional reactions while caring for critically ill patients, and how this can be interpreted and addressed as a patient safety issue.DiscussionED health care providers encounter high-stakes, high-stress clinical scenarios, such as pediatric cardiac arrest or resuscitation. This health care providers’ stress, and at times, distress, and its potential contribution to medical error, is underrepresented in the current medical literature. Most patient safety research is limited to error reporting systems, especially medication-related ones, an approach that ignores the effects of health care provider stress as a source of error, and limits our ability to learn from the event. Ways to mitigate this stress and avoid this type of patient safety concern might include simulation training for rare, high-acuity events, use of pre-determined clinical order sets, and post-event debriefing.ConclusionWhile there are physiologic and anatomic differences that contribute to patient safety, we believe that they are insufficient to explain the need to address critical life-threatening event-related patient safety issues for both adults and, especially, children. Many factors make patient safety during critical medical events distinct from general patient safety issues, but it is, perhaps, this heightened high-stress, emotional climate that is the most distinct and important part of all. We believe that consideration of this concept is essential when discussing safety improvement in critical medical events.

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“…Despite their limitations, adherence to current pediatric sepsis guidelines, as detailed in the pediatric section of the surviving sepsis campaign, are associated with improved outcomes (Figure 2) (10, 12, 21-23). However, multiple studies have documented low compliance (24) and in a simulated ED setting only 45% of teams correctly adhered to all six sepsis metrics (12). One method that has consistently increased adherence to published guidelines is implementation of protocols (18).…”

Section: Managementmentioning

confidence: 99%

Pediatric sepsis

Mathias

Mira

Larson

2016

Current Opinion in Pediatrics

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Purpose of Review Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72,000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis. Recent Findings The definition of pediatric sepsis is currently in a state of evolution and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice. Despite this, it is the speed of diagnosis and the timely implementation of current treatment guidelines that has been shown to improve outcomes. However, adherence to treatment guidelines is currently low and it is only through the implementation of protocols that improved care and outcomes have been demonstrated. Summary Current management of pediatric sepsis is largely based on adaptations from adult sepsis treatment; however, distinct physiology demands more prospective pediatric trials to tailor management to the pediatric population. Adherence to current and emerging practice guidelines will require that protocolized care pathways become commonplace.

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Disparities in Adherence to Pediatric Sepsis Guidelines across a Spectrum of Emergency Departments: A Multicenter, Cross-Sectional Observational In Situ Simulation Study

Cited by 77 publications

References 63 publications

Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre‐based, high fidelity scenarios

Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre‐based, high fidelity scenarios

High stakes and high emotions: providing safe care in Canadian emergency departments

Pediatric sepsis

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