Award Candidate Poster Presentation
Implementation of pediatric emergency in situ simulations in Latvia
Tuesday, May 15
09:45 - 10:45
Location: Saturn 1&2
Background: : Pediatric emergency medicine is not recognized as a separate subspecialty in Latvia and most emergencies are attended by general pediatricians or pediatric surgeons, while more severe cases are treated by pediatric intensivists. Recent pediatric readiness assessment has demonstrated the need for more formal training in pediatric emergency management of the staff of the only pediatric children’s hospital in Latvia.
Research Question: : Our aims were to (i) train the multidisciplinary team in pediatric emergencies, (ii) evaluate their confidence, technical skills and teamwork and (iii) assess quality of simulation delivery.
Methodology: : We carried out a prospective observational study using in situ simulation. During the study we implemented a monthly in situ simulation training program in the Emergency Department of Children's Clinical University Hospital - the only pediatric hospital in Latvia with a patient volume of about 70 000 annual visits. Eight different scenarios were used during 11 in situ simulation sessions including hypovolemic shock, septic shock, hemorrhagic shock, seizure, ventricular fibrillation, drowning, anaphylaxis and diabetic ketoacidosis. Participants were 8 pediatricians, 4 pediatric surgeons, 10 residents and 21 nurses. Simulation team assessment tool (STAT) was used to evaluate participants’ technical skills and human factors. Debriefing Assessment for Simulation in Healthcare (DASH) tool was used to assess the debriefing process. Custom questionnaire was used to analyze medical staff confidence in a critical situation.
Results: : The average score for STAT was 74 ±15%. The highest STAT score was achieved in septic shock scenario - 89%, compared to VF scenario were score was only 59%. According to DASH scores participants rated debriefing as very good or outstanding in the majority of dimensions. Only in 6 out of 23 positions 23% of participants evaluated part of debriefing as average or poor. DASH values remained high (6.4 average) throughout the project. Most doctors (N=19; 86%) reported not being completely confident while performing advanced life support in a critical situation, whereas majority of nurses reported as being completely confident in 3/8 dimensions provided. Feedback by all participants showed that the major benefits of the simulation were practice of technical skills and teamwork in real-life environment. All participants were willing to take part in simulations more often.
Discussion/Conclusions: : The feedback was extremely positive from both physicians and nurses, as well as from hospital managers. Participants found in situ simulations as a worthwhile tool to practice their skills, teamwork and to be more confident in critical situations.
Luize Bidina, MD
Children's clinical university hospital, Riga, Latvia
Baiba Ziemele, MD
Children's Clinical University Hospital, Riga, Latvia
Madara Blumberga, BSN
Nurse in Pediatric Emergency Medicine
Children's Clinical University hospital, Riga, Latvia
Catherine Allan, MD
Associate Program Director - Simulator Program
Boston Children's Hospital