Pennsylvania — Targeted Issue

Description

Web-based pediatric resuscitation quality self-assessment toolkit for emergency care. Self Assessment through Video Evaluation for Performance improvement in Emergency Department-based pediatric resuscitation.

Author(s)/Presenter(s)

Sage R Myers, Aaron J Donoghue

Abstract/Description

Purpose of review: The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change.

Recent findings: Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation.

Summary: Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.

Author(s)/Presenter(s)

Julia Price, PhD, Lucas Butler, BA, Charmin Gohel, MD, et al

Abstract/Description

BACKGROUND: Family-centered care (FCC) and trauma-informed care (TIC) involves engaging patients and families in care/decision-making and minimizing distress. FCC and TIC are associated with improved health outcomes and patient/family experience. Concrete definitions of relevant provider behaviors are lacking, and there is no validated tool to assess FCC/TIC. We aimed to develop a tool to evaluate FCC/TIC during acute pediatric care.
METHODS: We reviewed key policy statements, guidelines, and empirical literature to identify domains of FCC/TIC and specific provider/team behaviors within each domain that comprise FCC/TIC. We further honed the list of behaviors via 1) video review of 26 in-situ simulated pediatric acute care in pediatric and general EDs, 2) iterative qualitative feedback from a multidisciplinary expert panel. We are now conducting interviews with ED providers and parents of children who were present when their child required acute care.
RESULTS: We identified 6 domains of FCC/TIC: sharing information with patients and families, family involvement in care/decisions, addressing family needs/distress, addressing patient distress (pain, emotional distress), promoting effective emotional support for patients, and developmental and cultural competence. We identified 38 unique provider/team behaviors and incorporated these into a measurement tool for FCC/TIC.
CONCLUSIONS: Tools to assess and improve current FCC/TIC practices in pediatric acute care are needed. This work defined distinct domains and a first iteration of specific, measurable provider/team behaviors. The prototype tool can be used for educational and quality improvement efforts. Future research will assess its reliability, validity, and association with patient/family experience and outcomes.

Author(s)/Presenter(s)

Kassam-Adams, Nancy, PhD; Auerbach, Marc, MD, MsC; Butler, Lucas, BS; Nadkarni, Vinay, MD, MS

Abstract/Description

For pediatric patients and families, sudden, time- critical medical procedures are extremely stressful and put them at risk for psychological sequellae. Trauma-informed care (minimizing frightening aspects of treatment, attending to pain and emotional distress) can reduce PTSS risk, but is a particular challenge during acute medical care when there are many competing priorities for the medical team's attention and focus. In emergency medicine, simulation-based methods are widely used for quality improvement (QI) of complex interventions - medical teams respond in real time to realistic time-critical medical situations with high-fidelity mannequins as patients and actors as parents. We are harnessing these methods to integrate trauma-informed care into ongoing QI in emergency medical settings. Our multi-disciplinary team first identified observable behaviors relevant to trauma-informed care during acute procedures, based on evidence and best practice guidelines. We refined these metrics via video review of 26 simulated pediatric resuscitation scenarios and interviews with providers and parents. Next steps are to use these tools to help medical teams benchmark current practice, guide post-simulation review, and identify targeted training needs. Simulation-based QI appears to be a promising method to assess and improve trauma-informed care during pediatric emergency care.