Award Candidate Poster Presentation

Poster

A simulation-based approach to improving Paediatric resuscitation in a tertiary Children's Hospital

Tuesday, May 15
09:45 - 10:45
Location: Neptune 1&2

Abstract : Background
The rates of paediatric cardiac arrests are low [1] and staff have limited opportunities to practise resuscitation-related skills. Indeed, there were only 6 cardiac arrests on Bristol Royal Hospital for Children’s (BRHC) wards in the 18 months prior to this initiative. Furthermore, staff feedback highlighted concerns that cardiac arrests could feel chaotic and disorganised without clear leadership. Previously, the ward Medical Emergency Team rarely met prior to an emergency and had limited knowledge of each other’s skillsets or the high-risk inpatients. Only 25.5% of staff involved in arrests reported being offered the chance to debrief following the event. Additionally, in accordance with national guidance, staff are mandated to attend basic life support courses once every 2 years and may not receive interim practice of chest compression or ventilation skills despite concern that these skills depreciate significantly after 3 months [2].

A Quality Improvement (QI) project is therefore being undertaken with aims of reducing rates of inpatient cardiac arrests and improving management of inpatient emergencies (outside of Paediatric Intensive Care and ED). These are complex goals and therefore a multi-faceted simulation-based approach is being used.

Educational goals and proposed approaches
Using a QI framework, primary and secondary drivers were identified and change ideas were devised (Table 1). The solutions detailed in Table 1 can be clustered into 5 components:
1. Paediatric Medical Emergency Team Huddles
2. Regular simulated deliberate practice of chest compressions and bag-valve mask ventilation
3. Simulated Just-In-Time training
4. Regular medical emergency point-of-care simulations
5. Hot Debriefs for inpatient emergencies
Each component is being introduced after stakeholder consultation and pilot simulations in point-of-care sessions, targeted sessions or courses.

Difficulties encountered
All project components have encountered similar difficulties. Finding sufficient time for staff to attend simulations has proved challenging, often reinforced by English healthcare’s short-sighted perception that non-essential activity such as simulation is of low priority. There have been staff anxieties regarding resuscitation-based simulations as opposed to less emotive or challenging scenarios. This coupled with the valid recognition that learner-centred rather than educator-centred learning outcomes ought to be targeted, has meant that resuscitation scenarios have often been abandoned in favour of less complex ones. There have been challenges in involving some sub-specialities due to restricted staff time, low engagement from team leads and the perceived level of relevance to their patient groups. Conversely, for those faculty who have assisted in simulation, there have been challenges regarding consistency in facilitator expertise and quality of simulation delivery.

Questions for discussion
- How to engage staff in simulation despite a time-poor environment and differences in learner-centred and organisation-centred learning aims.
- How to run simulations in sub-specialities in a large hospital to a consistently high standard whilst also encouraging those faculty to run them independently in order to develop a sustainable model of simulation-based education
- The challenges of developing a Hot Debrief proforma which can be used by any member of staff who is not ‘debrief trained’ following a medical emergency on the wards





Emily Sloper, BMBS, BMedSci, MRCPCH

Paediatric Registrar
University Hospitals Bristol NHS Foundation Trust
Bristol, England, United Kingdom

Dr Emily Sloper, BMBS, BMedSci, MRCPCH
Affiliation: University Hospitals Bristol NHS Foundation Trust

I am a Paediatric Registrar and have completed a 12 month clinical fellowship working as a Quality Improvement Fellow looking at Paediatric Resuscitation and escalation of care in a tertiary Children's Hospital in the English National Health Service.

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Katherine Baptiste, BSc, RNC

Paediatric Quality Improvement Fellow
University Hospitals Bristol NHS Foundation Trust
Bristol, England, United Kingdom

Katherine Baptiste (Registered Nurse, BSc Hons) Paediatric Quality Improvement Fellow, Affiliations: Bristol Royal Hospital for Children, University Hospitals Brist NHF Foundation Trust

I have a background in Paediatric Intensive Care. I have just finished a 12 month fellowship in Paediatric Quality Improvement, looking specifically at improving the escalation of care and resuscitation in a tertiary Children’s hospital.

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David Grant, MBChB, MRPCH, FFICM

Paediatric Intensive Care Consultant, Bristol Medical Simulation Centre Chair
University Hospitals Bristol NHS Foundation Trust
Bristol

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Jo Hegarty, MD, PhD

Neonatologist
Starship Child Health, Auckland, New Zealand

Dr Jo Hegarty MB BCh BAO, MRCPCH, FRACP, PhD is a Neonatologist at Starship NICU in Auckland, New Zealand and Co-Chair of the IPSS Education Committee. She is a member of the Starship Hospital Simulation faculty and leads the simulation programme in Starship NICU. Recent initiatives include development of a hospital wide ‘hot debriefing’ project and an interdisciplinary ‘difficult conversations workshop’. Her key simulation interests include education, communication and patient safety.

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