Traditional Poster Round
Background: : Simulation-based Education (SBE) is a fast-growing field that can enhance existing patient education by creating a safe learning environment where crucial routine and emergency skills can be taught through enhanced teach-back prior to hospital discharge. The Simulation-based Discharge Program (SDP) at the NewYork-Presbyterian Weill Cornell Medical Center Komansky Children's Hospital was developed through a joint effort of the Family Advisory Council (FAC) and an interprofessional committee of physicians, nurses, and social workers to provide SBE for caregivers of technology-dependent children. SDP is deliberately designed to focus on the acquisition of basic skills in order to create an accessible and replicable program even for pediatric hospitals that might not have a strong simulation program.
Research Question: : To determine if SBE will be associated with an improvement in caregiver’s self-reported comfort and simulation-based assessment of skills in caring for their child with tracheostomy.
Methodology: : A pre and post quasi-experimental design was used to assess caregiver’s self-reported comfort and assessment of skills with tracheostomy care after SBE at a tertiary children’s hospital over two years. An 18-items survey assessed caregiver’s self-reported comfort and knowledge on a 5-level Likert scale. Seven basic demographics questions also accompanied this survey. A simulation-based skills assessment based on a 27-items checklist objectively assessed caregiver’s skills. Wilcoxon signed-rank test was used to analyse survey data and t-paired samples test for checklist results.
Results: : Twenty-seven caregivers participated in our program and completed surveys while a subgroup of eight also completed the checklist. Of the 27 caregivers, 44% were between age of 35-44 and 59% were female. 26% of participants had a 4 year college degree and 33% had more than college degrees. 59% had private health insurance. The survey results showed significant improvements in self-reported comfort level in tracheostomy care that include general care (p=0.0072), suctioning (p=0.0024), and changing tracheostomy (p=0.0038) pre and post SBE. There were also significant improvements in self-reported confidence in knowing how to perform suctioning (p=0.0042) and tracheostomy tube change (p<0.001). The standardized checklist provided an objective skills assessment on tracheostomy care, with the total score post-SBE significantly higher than the pre-SBE total score (t=-5.8, p<0.01). Before SBE, caregivers were able to complete, on average, only 69% of the checklist items. After SBE, they can complete, on average, 87% of the items. An improvement was noted in the number of caregivers who were able to perform skin care (1 vs 5), tie change (3 vs 5), sterile gloving (2 vs 6), and suctioning (1 vs 5) according to our standard of care pre- and post-SBE. Tracheostomy tube change remained a difficult skill to master with only 2 out of 8 able to perform it completely post SBE.
Discussion/Conclusions: : This pilot study revealed a significant improvement in caregivers’ comfort, confidence and skills in caring for their child’s tracheostomy following SBE. While caregiver’s skill level did significantly improve across all areas, most still struggle with tracheostomy tube change including maintaining sterility during preparation and removing the obturator after the new tracheostomy is placed. Further SBE on this skill may help improve performance. Next steps include assessing the impact of peer support, and retention of comfort and skills after SBE.