Award Candidate Poster Presentation


Process Improvement of Crisis Resource Management with Low Fidelity Simulation

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

Abstract : Background: In situ simulation has multiple pedagogical benefits in training members of the care team such as assuring competence in technical and non-technical skills. It has also been shown as an effective method to identify potential latent safety threats (LSTs). While it is theorized that improvement in recognition of LSTs and increased in situ simulation will improve competency skills, to our knowledge, it has not yet been demonstrated that intervention upon these LSTs has been associated with improved outcomes in the pediatric critical care setting.
Our study is designed to look at whether the use of low fidelity simulation to identify and intervene upon LSTs with process improvement points impacts future performance in repeat simulation. Our hope is that by demonstrating improved performance with process related improvements, this will translate to improved patient outcomes.

Research Question: The goal of the study is to evaluate frequent, low fidelity in situ simulation as a continuous improvement method to identify LSTs in the pediatric critical care setting. We hypothesize that process related interventions continuously monitored by a high frequency low-fidelity simulation program will be associated with improved performance measures in real acute care events.
Proposed Approach: Our study will be performed as a prospective cohort study with data collection performed in two phases in the form of validated qualitative surveys between the period of 9/2017 until 4/2018 at Cohen’s Children’s Medical Center in the pediatric intensive care unit.
LSTs are pre-identified from prior baseline data collected qualitatively and involve four primary areas of focus including equipment, knowledge, logistics and human factors. LSTs will be used with a specific process intervention to be designed for an area of knowledge deficit as it related to identification and intervention upon cardiac tamponade. All simulation scenarios pertaining to such will be observed by a third person party and scored for performance and crisis management skills using Ottawa GRS and Ottawa CRM score.
Residents within the intervention group were provided with a resource tool used to familiarize them with normal baseline vital sign parameters (including heart rate, blood pressure and saturations) with the intention of increasing awareness of abnormalities during simulation scenarios and prompting recognition of cardiac tamponade physiology.
Pre-intervention and post intervention data will be collected during the first and last two weeks of each resident rotation month respectively. During the post intervention period, repeat scenarios will be performed with low fidelity bedside in-situ simulation with the designed resource tool available. Repeated observer scoring will be performed and compared with pre-intervention baseline scores to assess for statistical significance.
1) Obtaining data points with frequent simulation
2) How to reduce bias
3) How do we compare with real life adverse event prevention
4) Maintaining interdisciplinary nature of the simulations with nursing and ancillary service buy-in.
Questions for Discussion:
1) How can we improve study design?
2) Taxonomy of LSTs—should we adopt Failure modes analysis
3) Demonstrating improvement by surrogate quantitative measures in a meaningful way?
4) Developing a national database of participating programs so that identified LSTs can be generalized and interventions can be extrapolatable

Grace L. Ker, MD

Pediatric Critical Care
New Hyde Park, New York


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Sandeep Gangadharan, MD

None Currently


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Lauren Demarco, Research Assistant

Research Assistant
Cohen Childrens Medical Center


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Jo Hegarty, MD, PhD

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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Process Improvement of Crisis Resource Management with Low Fidelity Simulation


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