State Spotlight: Advancing excellence in Delaware through simulation and collaboration

Given the relative infrequency of pediatric cases for some EDs, pediatric simulation is vital for effectively equipping clinicians to handle pediatric emergencies. We spoke with Maria Carmen G. Diaz, ​​MD, FAAP, FACEP, chair of the EMSC Advisory Committee of Delaware and medical director of simulation at Nemours Institute for Clinical Excellence (NICE), about how NICE is partnering with Delaware EMSC to elevate pediatric simulation across the state by incorporating it into recognition program site visits.

Part of Nemours Children’s Health, NICE, established in 2013, integrates simulation services across Nemours Children’s Health, Delaware Valley, and its American Heart Association and the Emergency Nurse Association training centers. NICE’s collaborative teaching and education efforts enhance participants’ technical, cognitive, and behavioral skills in a controlled, realistic environment.

Integration simulation into recognition programs

Currently, all Delaware hospitals and free-standing EDs participate in a Pediatric Emergency Care Facility Recognition Program through the Delaware EMSC Program. Recognition programs create a statewide system of care with defined pediatric standards, metrics, and ongoing collaboration. In partnership with NICE, Delaware EMSC incorporates collaborative, simulation-based sessions as part of site visits. This provides teams with the opportunity to demonstrate and highlight their pediatric specific skills and use of their own pediatric equipment.

“During our first round of site visits over 10 years ago, we used a checklist to ensure facilities had appropriate pediatric equipment and supplies,” says Diaz “Numerous discussions site visits made us recognize that facilities wanted to do more than just confirm presence of equipment and wanted to discuss optimal usage of what was on that checklist. This prompted me to use my simulation expertise to make the site visits more interactive. During each site visit, I ask teams to use their own equipment and supplies as they resuscitate a simulated pediatric patient. This allows teams to showcase their pediatric specific inventory as they highlight their skills and knowledge”

Diaz uses the simulations to ensure adherence with statewide standards and as a forum for shared learnings and best practices.

“Our simulations are always collaborative; we learn from each other and share findings across our state. All facilities love these simulations and even reach out for more.”

Educational offerings for both EMS and EDs

NICE also offers regional and national courses focusing on specific clinician groups. Delaware EMSC currently supports hands-on, day-long EMS courses for agencies in the state, which are conducted annually. During these courses, participants can learn, incorporate, and apply pediatric-specific skills during various simulation-based scenarios.

EMS participants share positive feedback, citing increased self-efficacy in skills such as intubation and pediatric vascular access. Many attendees highlight the value of hands-on training and real-life applications learned during courses.

To navigate the unique challenges of training needs from hospital to prehospital clinicians, NICE conducts annual needs assessments from each course and groups of learners. This considers evaluations from the prior year, aggregate clinical data/trends from patient encounters, advances in literature, patient safety findings, and required elements deemed necessary by overarching accrediting bodies.

If you would like more information on Delaware's EMSC program or their hospital recognition program, contact Crystal Spence at crystal.spence@delaware.gov or visit their website at https://dhss.delaware.gov/dhss/dph/ems/emsc.html.