Traditional Poster Round
Introduction: Although simulation is increasingly being used in pediatric cardiovascular intensive care units (CVICU) with residents, fellows or advanced practice providers (APP), there are few examples of how to rigorously design a simulation to evaluate and study interprofessional education in a CVICU with no trainees or advanced care providers like nurse practitioners or physician assistants.
Objectives: To use existing best practice recommendations to develop a simulation to study conflict management in ICUs, then assess the feasibility, acceptability, and realism of the simulation among CVICU attendings.
Methods: The setting was a CVICU/PICU of a tertiary care non childrens hospital that had a new (five years) Congenital Heart Program. Participants were five CVICU attendings (0 to 20 years out of training), nurses, respiratory therapists, anesthesiologists, pharmacists, cardiac surgeons (no trainees or advanced practice providers) in scenarios adapted from the “Curriculum for Pediatric Cardiac Critical Care Medicine”, a publication from PCICS. Using best-practice guidelines and an iterative, multidisciplinary approach, we refined the curriculum for in-situ simulation based on the needs of the multidisciplinary team to assess the feasibility, acceptability, and realism of the simulation. A running document named “Lessons learnt during simulation” was circulated amongst the team members on a quarterly basis.
Measurements and Main Results: All participants successfully completed the simulation and participants reported benefits, quality, realism of simulation across a range of criteria, with mean ratings of greater than 4 on a 1 to 5 (low to high) scale for all domains assessed. During semi-structured interviews, participants offered suggestions for improvements. The process change was implemented after PDSA cycles-after the prebrief we included a step named the “RN/RT” checklist. This step involved the team getting familiar with the medications, lines, respiratory equipment on the mannequin to validate (question or gather) information not in alignment with a real patient. The simulations conducted after inclusion of this step achieved minimizing the ‘suspended disbelief” and strengthening the realism in these in-situ simulations.
Conclusion and challenges: Interprofessional simulation education is feasible and perceived as beneficial by multidisciplinary team members in a non-trainee or non-APP staffed CVICU. Further research is needed regarding establishing criteria for curriculum development and assessment in a non-trainee environment. The challenges around running a meaningfully productive simulation program in a small to moderate size intensive care unit with varying census need ongoing innovation and research.