Oral Themed Presentation
Background: : Pediatric disaster triage (PDT) is challenging for healthcare personnel. Mistriage is inefficient and leads to poor resource utilization. Live simulation is resource intense while computer-based simulation (CBS) is highly reproducible and less costly. Benefits of using CBS for disaster triage education have never been evaluated for emergency department nurses.
Research Question: : Is CBS effective as a modality for learning PDT among emergency nursing personnel?
We hypothesized that CBS would be effective as a modality for learning PDT by emergency nursing personnel.
Methodology: : Prospective observational study at two tertiary-care emergency departments. Instructional Designers constructed a CBS replicating live PDT scenarios to prompt decisions nurses must make during PD events (house fire, school shooting, tornado). Through combination of video, avatar, flash animation, and graphic representation, nurse study participants must make decisions that are compared against pre-defined triage algorithms (JumpSTART). CBS can assess triage speed, accuracy, and whether learners are using the algorithm or randomly. Learners were required to play the game 5 times (week 1 (time 0), and at weeks 4,7,10 and 13).
Efficacy was assessed by measuring learners’ triage accuracy and instances of mistriage using JumpSTART. Time 0 assessed existing knowledge and learners were again assessed at week 13. This was assessed using a Wilcoxon Rank Sum Test.
Achieving success rates of >80% of learners performing PDT with an accuracy of>/=90% at week 13 is considered success. Descriptive statistics of the number of victims properly triaged, instances of mistriage, and triage speed were calculated.Triage accuracy was defined as the expected triage level being assigned to the patient.
Results: : A total of 138 nurses participated in the study.
Triage accuracy improved from a median of 61.1 (IQR 48.5, 72.0) to median of 91.7 (IQR 60.4, 95.8), p<0.0001. Instances of mistriage decreased from median of 38.9 (IQR: 28.0, 51.5) to median of 8.3 (IQR: 4.2, 39.6), p<0.0001.
The median number of game plays was 6 (IQR 3,8).
Discussion/Conclusions: : Our results demonstrate that CBS is effective as a modality for learning PDT by emergency nursing personnel. The intervention demonstrated a significant improvement in accuracy from baseline to last attempt. Instances of mistriage decreased significantly between first and last attempts. The benefits of the CBS PDT to nurses and the communities they serve will allow for a more efficacious and fair allocation of resources in a disaster situation. This training has the potential to mitigate the trend of performing mistriage on pediatric victims of disasters and subsequently improve the outcomes of healthcare treatment that follows triage. Opportunities to promote "Just in time (JIT)" training using CBS in case of major disasters may be beneficial to the paediatric healthcare simulation community.
Future studies should explore long-term knowledge and skill retention using CBS as a modality for learning PDT.