Who Trains the Trainers?: Development of a Faculty Bootcamp for Pediatric Emergency Medicine Resuscitation Procedures.

OBJECTIVES: Attending physicians in pediatric emergency medicine (PEM) must be able to perform lifesaving procedures, yet guidelines for maintaining procedural competency do not exist. We implemented a biannual 2-hour "bootcamp" designed to help PEM faculty maintain procedural competency. METHODS: A survey-based needs assessment was used to create a set of goals and objectives for the session and determine which procedural skills to include. Sessions of 4 simulated skills were held twice a year and limited to 12 faculty. Post-bootcamp evaluations were administered at the 1-year and 6-year marks to evaluate the usefulness of the training. RESULTS: Twenty-eight of our 55 current faculty members (50%) responded to the 6-year follow-up evaluation. Overall, the bootcamp was felt to be beneficial, with 64% of faculty rating it "great" (5) or "highly useful" (6) on a 6-point Likert scale. The majority of participants also rated the airway, vascular access, and cardiopulmonary resuscitation/defibrillator training favorably. Faculty who later had the opportunity to perform specific resuscitation procedures clinically felt that the circulation (cardiopulmonary resuscitation/defibrillator) and airway stations contributed to the success of their procedure performance. CONCLUSIONS: The clinical setting alone may be insufficient in maintaining procedural competency in lifesaving skills in PEM. Giving faculty the opportunity to practice these skills is feasible and can be effective in increasing confidence. Future training sessions should aim toward practicing to a defined mastery level.

Simulation as a Dynamic Tool to Reorganize Pediatric Emergency Department Resuscitation During the Coronavirus Disease 2019 Pandemic and Beyond.

BACKGROUND: The coronavirus disease 2019 pandemic has challenged hospitals and pediatric emergency department (PED) providers to rapidly adjust numerous facets of the care of critically ill or injured children to minimize health care worker (HCW) exposure to severe acute respiratory syndrome coronavirus 2. OBJECTIVE: We aimed to iteratively devise protocols and processes that minimized HCW exposure while safely and effectively caring for children who may require unanticipated aerosol-generating procedures. METHODS: As part of our PED's initiative to optimize clinical care and HCW safety during the coronavirus disease 2019 pandemic, regular multidisciplinary systems and process simulation sessions were conducted. These sessions allowed us to evaluate and reorganize patient flow, test and improve communication modalities, alter the process for consultation in resuscitations, and teach and reinforce the appropriate donning and use of personal protective equipment. RESULTS: Simulation was a highly effective method to disseminate new practices to PED staff. Numerous workflow modifications were implemented as a result of our in situ systems and process simulations. Total number of persons in the resuscitation room was minimized, use of a "command post" with remote providers was initiated, communication devices and strategies were trialed and adopted, and personal protective equipment standards that optimized HCW safety and communication were enacted. CONCLUSIONS: Simulation can be an effective and agile tool in restructuring patient workflow and care of the most critically ill or injured patients in a PED during a novel pandemic.

Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments.

Background: Determining when to entrust trainees to perform procedures is fundamental to patient safety and competency development. Objective: To determine whether simulation-based readiness assessments of first year residents immediately prior to their first supervised infant lumbar punctures (LPs) are associated with success. Methods: This prospective cohort study enrolled paediatric and other first year residents who perform LPs at 35 academic hospitals from 2012 to 2014. Within a standardised LP curriculum, a validated 4-point readiness assessment of first year residents was required immediately prior to their first supervised LP. A score ≥3 was required for residents to perform the LP. The proportion of successful LPs (<1000 red blood cells on first attempt) was determined. Process measures included success on any attempt, number of attempts, analgesia usage and use of the early stylet removal technique. Results: We analysed 726 LPs reported from 1722 residents (42%). Of the 432 who underwent readiness assessments, 174 (40%, 95% CI 36% to 45%) successfully performed their first LP. Those who were not assessed succeeded in 103/294 (35%, 95% CI 30% to 41%) LPs. Assessed participants reported more frequent direct attending supervision of the LP (diff 16%; 95% CI 8% to 22%), greater use of topical analgesia (diff 6%; 95% CI 1% to 12%) and greater use of the early stylet removal technique (diff 11%; 95% CI 4% to 19%) but no difference in number of attempts or overall procedural success. Conclusions: Simulation-based readiness assessments performed in a point-of-care fashion were associated with several desirable behaviours but were not associated with greater clinical success with LP.