Quality of clinical care provided during simulated pediatric cardiac arrest: a simulation-based study

Garcia-Jorda, Dailys; Martin, Dori-Ann; Camphaug, Jenna; Bissett, Wendy; Spence, Tara; Mahoney, Meagan; Cheng, Adam; Lin, Yiqun; Gilfoyle, Elaine

doi:10.1007/s12630-020-01665-w

Cited by 4 publications

(6 citation statements)

References 39 publications

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“…Asystole was the most frequent first documented rhythm. Median (IQR) EMS response time was 5 (4-7) minutes, time on scene was 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) We identified a total of 1116 severe ASEs. Overall, 610 patients (60%) had at least 1 severe ASE, and 310 (30%) had 2 or more severe ASEs (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest

Eriksson,

Bahr,

Meckler

et al. 2024

JAMA Netw Open

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ImportanceSurvival for children with out-of-hospital cardiac arrest (OHCA) remains poor despite improvements in adult OHCA survival.ObjectiveTo characterize the frequency of and factors associated with adverse safety events (ASEs) in pediatric OHCA.Design, Setting, and ParticipantsThis population-based retrospective cohort study examined patient care reports from 51 emergency medical services (EMS) agencies in California, Georgia, Oregon, Pennsylvania, Texas, and Wisconsin for children younger than 18 years with an OHCA in which resuscitation was attempted by EMS personnel between 2013 and 2019. Medical record review was conducted from January 2019 to April 2022 and data analysis from October 2022 to February 2023.Main Outcomes and MeasureSevere ASEs during the patient encounter (eg, failure to give an indicated medication, 10-fold medication overdose).ResultsA total of 1019 encounters of EMS-treated pediatric OHCA were evaluated; 465 patients (46%) were younger than 12 months. At least 1 severe ASE occurred in 610 patients (60%), and 310 patients (30%) had 2 or more. Neonates had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (332 [30%]), vascular access (212 [19%]), and ventilation (160 [14%]). In multivariable logistic regression, the only factor associated with severe ASEs was young age. Neonates with birth-related and non–birth-related OHCA had greater odds of a severe ASE compared with adolescents (birth-related: odds ratio [OR], 7.0; 95% CI, 3.1-16.1; non–birth-related: OR, 3.4; 95% CI, 1.2-9.6).Conclusions and RelevanceIn this large geographically diverse cohort of children with EMS-treated OHCA, 60% of all patients experienced at least 1 severe ASE. The odds of a severe ASE were higher for neonates than adolescents and even higher when the cardiac arrest was birth related. Given the national increase in out-of-hospital births and ongoing poor outcomes of OHCA in young children, these findings represent an urgent call to action to improve care delivery and training for this population.

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Section: Resultsmentioning

confidence: 99%

Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest

Eriksson,

Bahr,

Meckler

et al. 2024

JAMA Netw Open

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“…A total of 104 PICU staff (PICU attending physicians, nurse practitioners, registered nurses, respiratory therapists, and rotating medical residents) participated in 25 in situ pediatric cardiac arrest simulations, all of which were included for video review and analysis. Number of participants, their professional characteristics, and demographics are published elsewhere 17 . See the Supplemental Digital Content 1 (see document, Supplementary Digital Content 1, http://links.lww.com/SIH/A865, diagram of the room) for a diagram of the room where the simulations took place showing the position of the equipment and video recording setup.…”

Section: Resultsmentioning

confidence: 99%

“…Number of participants, their professional characteristics, and demographics are published elsewhere. 17…”

Section: Resultsmentioning

confidence: 99%

“…A cardiopulmonary resuscitation (CPR) quality educational bundle was implemented in the pediatric intensive care unit (PICU) at the Alberta Children's Hospital, Calgary, Canada, from September 3, 2015, to November 22, 2016. We previously reported suboptimal compliance with resuscitation guidelines from analysis of video-recorded simulated pediatric cardiac arrest events that were captured as part of this project 17 . In this study, we report a secondary analysis of these video-recorded simulated events (Table 1).…”

Section: Methodsmentioning

confidence: 98%

“…We previously reported suboptimal compliance with resuscitation guidelines from analysis of video-recorded simulated pediatric cardiac arrest events that were captured as part of this project. 17 In this study, we report a secondary analysis of these video-recorded simulated events (Table 1).…”

Section: Methods Study Design and Settingmentioning

confidence: 99%

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Video Review of Simulated Pediatric Cardiac Arrest to Identify Errors/Latent Safety Threats: A Mixed Methods Study

Garcia-Jorda¹,

Nikitovic²,

Gilfoyle³

2022

Sim Healthcare

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Introduction: Outcomes from pediatric in-hospital cardiac arrest depend on the treatment provided as well as resuscitation team performance. Our study aimed to identify errors occurring in this clinical context and develop an analytical framework to classify them. This analytical framework provided a better understanding of team performance, leading to improved patient outcomes. Methods: We analyzed 25 video recordings of pediatric cardiac arrest simulations from the pediatric intensive care unit at the Alberta Children's Hospital. We conducted a qualitative-dominant crossover mixed method analysis to produce a broad understanding of the etiology of errors. Using qualitative framework analysis, we identified and qualitatively described errors and transformed the data coded into quantitative data to determine the frequency of errors. Results: We identified 546 errors/error-related actions and behaviors and 25 near misses. The errors were coded into 21 codes that were organized into 5 main themes. Clinical task-related errors accounted for most errors (41.9%), followed by planning, and executing task-related errors (22.3%), distraction-related errors (18.7%), communication-related errors (10.1%), and knowledge/training-related errors (7%). Conclusions: This novel analytical framework can robustly identify, classify, and describe the root causes of errors within this complex clinical context. Future validation of this classification of errors and error-related actions and behaviors on larger samples of resuscitations from various contexts will allow for a better understanding of how errors can be mitigated to improve patient outcomes.

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Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool

Bahr

Meckler

Hansen

et al. 2021

The American Journal of Emergency Medicine

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Quality of clinical care provided during simulated pediatric cardiac arrest: a simulation-based study

Cited by 4 publications

References 39 publications

Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest

Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest

Video Review of Simulated Pediatric Cardiac Arrest to Identify Errors/Latent Safety Threats: A Mixed Methods Study

Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool

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