Prediction of clinical deterioration after admission from the pediatric emergency department.

BACKGROUND: An ongoing threat to hospitalized patients is delayed recognition of clinical deterioration and its association with increased morbidity and mortality. OBJECTIVE: This study evaluated the ability of Pediatric Emergency Medicine (PEM) clinicians to predict clinical deterioration of patients admitted from the Pediatric Emergency Department (PED). Clinical deterioration was defined as unanticipated transfer to an Intensive Care Unit (ICU) within 12 h of PED-to-ward admission. METHODS: This prospective study was conducted in the PED of an urban, academic, tertiary-care children's hospital. Nurses, attending physicians, fellows, and residents completed surveys about their predicted risk of clinical deterioration for each patient admitted to the pediatric ward using a visual analog scale (VAS), and their level of certainty in their prediction using a Likert scale. Additional data included clinician years of experience, and continuity of care versus patient hand-off between clinicians. RESULTS: 4482 surveys were completed by clinicians for 2892 unique admissions over ten months. Twenty-two patients required transfer to an ICU within 12 h of PED-to-ward admission. Nurses' predictions of deterioration risk were higher for patients who went on to require ICU transfer than for patients who did not. Level of certainty correlated with years of clinician experience and with continuity of care, and was higher for patients predicted to have a low risk of deterioration. CONCLUSIONS: Clinicians are more certain of their predictions with increasing experience, continuity of care, and when predicted risk is low.

Introducing Teamwork Challenges in Simulation Using Game Cards.

STATEMENT: Poor teamwork and communication during resuscitations are linked to patient safety problems and poorer outcomes. We present a novel simulation-based educational intervention using game cards to introduce challenges in teamwork. This intervention uses sets of game cards that designate roles, limitations, or communication challenges designed to introduce common communication or teamwork problems. Game cards are designed to be applicable for any simulation-based scenario and are independent from patient physiology. In our example, participants were pediatric emergency medicine fellows undergoing simulation training for orientation. We describe the use of card sets in different scenarios with increasing teamwork challenge and difficulty. Both postscenario and summative debriefings were facilitated to allow participants to reflect on their performance and discover ways to apply their strategies to real resuscitations. In this article, we present our experience with the novel use of game cards to modify simulation scenarios to improve communication and teamwork skills.