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INSPIRE @ IMSH 2015 ALERTs

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1. Bould - Cognitive Aids
2. Brown - Summative Feedback
3. Chang - CPR Leaderboards
4. Mallory - Simulation assessment & Pediatric Milestones
5. Moga - Acute Event Debriefing
6. MacKinnon - CPR High school simulations
7. Thyagaran - Pediatric simulation in India

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INSPIRE @ IMSH 2015 ALERTs

  1. 1. ALERT Presentation: Integrating Cognitive Aids (INCA) Dylan Bould, Sylvain Boet, Farhan Bhanji, Adam Cheng University of Ottawa, McGill, University of Calgary INSPIRE @ IMSH 2015 – New Orleans, LA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  2. 2. • Knowledge-based cognitive aids (CA) have the potential to improve performance • Previous research has neglected their implementation in actual interprofessional teams • We have developed a novel team-based CA International Network for Simulation-based Pediatric Innovation, Research and Education Background
  3. 3. • P: interprofessional teams in emergency and critical care • I: (factorial) knowledge-based CA, team-based CA, integration of both • C: no CA provided • O: adherence to PALS algorithm (measured by Clinical Performance Tool) International Network for Simulation-based Pediatric Innovation, Research and Education PICO / Research Question
  4. 4. International Network for Simulation-based Pediatric Innovation, Research and Education Approach / Design
  5. 5. • ALERT Presentation – January 2015 • Grant Proposal(s) – in progress – hope funding Spring 2015 • IRB Submission – Spring 2015 • Recruitment / Data Collection – Summer 2015 • Data Analysis – Summer 2016 • Abstract Presentation – Late 2016 • Manuscript Preparation – Late 2016 International Network for Simulation-based Pediatric Innovation, Research and Education Timeline
  6. 6. 1.What is the most compelling outcome measure to get large grants 2.Ideas for instructional design/format of e-Learning module 3.Can you see any “sub-studies”? International Network for Simulation-based Pediatric Innovation, Research and Education 3 questions to improve study
  7. 7. At INSPIRE @ IMSH 2015: Find collaborating centers In 2 months: (hope) receive funding and start pilots at lead site International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  8. 8. Dylan Bould Children’s Hospital of Eastern Ontario, University of Ottawa dylanbould@gmail.com International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information
  9. 9. The effect of summative feedback on the accuracy of provider perceptions and the quality of CPR during a simulated pediatric cardiac arrest. Linda L. Brown, MD MSCE and Adam Cheng, MD Hasbro Children’s Hospital / Brown University Alberta Children’s Hospital / University of Calgary INSPIRE @ IMSH 2015 – New Orleans, LA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  10. 10. • Quality CPR is a crucial component in survival from pediatric cardiac arrest • Healthcare providers (HCP) are often unaware of the quality of their CPR, even with real-time CPR feedback (VisF) • Summative feedback may improve skills, but little is known about its effect on CPR quality International Network for Simulation-based Pediatric Innovation, Research and Education Background
  11. 11. • P: CPR certified healthcare providers • I: Summative feedback regarding the quality of CPR • C: HCP with no summative feedback • O: Improved quality of CPR and improved accuracy of HCP perceptions International Network for Simulation-based Pediatric Innovation, Research and Education PICO / Research Question
  12. 12. International Network for Simulation-based Pediatric Innovation, Research and Education Approach / Design CPR trained HCP (randomized) Control Pediatric Cardiac Arrest Scenario With VisF Collect data on CPR Collect HCP perceptions Debrief Pediatric Cardiac Scenario #2 Collect data on CPR Collect HCP perceptions Debrief Intervention Pediatric Cardiac Arrest Scenario With VisF Collect data on CPR Collect HCP perceptions Debrief with summative feedback Pediatric Cardiac Arrest Scenario #2 Collect data on CPR Collect HCP perceptions Debrief with summative feedback
  13. 13. • ALERT Presentation 1/15 • Grant Proposal (if applicable) 2/15 • IRB Submission 2/15 • Recruitment / Data Collection Dependent on funding • Data Analysis • Abstract Presentation • Manuscript Preparation International Network for Simulation-based Pediatric Innovation, Research and Education Timeline
  14. 14. 1. What should be included for follow-up? 1. Another scenario 2. Individual HCP CPR 2. Time frame for follow-up? 3. Is this objective enough? International Network for Simulation-based Pediatric Innovation, Research and Education 3 questions to improve study
  15. 15. At INSPIRE @ IMSH 2015:  Refine/optimize research protocol  Input from group In 2 months: Complete grant applications International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  16. 16. Linda L. Brown, MD MSCE Alpert Medical School of Brown University/Hasbro Children’s Hospital lbrown8@lifespan.org 401-444-6237 International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information
  17. 17. ALERT Presentation: The use of Leaderboards & Competition to improve self-initiated CPR training Todd P Chang, MD MAcM Children’s Hospital Los Angeles Ralph J MacKinnon, MD Royal Manchester Children’s Hospital INSPIRE @ IMSH 2015 – New Orleans, LA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  18. 18. • Rolling self-initiated refreshers on CPR algorithms appear to improve skill (Kurosawa et al. 2014) • A clustering effect is seen when participants within a unit can compare CPR skill results using a Laerdal Q-CPR Mannequin (MacKinnon et al.) • We observed that friendly competition appears to increase a la carte practice of CPR up to 3 months International Network for Simulation-based Pediatric Innovation, Research and Education Background
  19. 19. • P: Healthcare providers (ICU, OR-Theatre, ED-A&E) • I: Access to Leaderboard & other units’ & institutions’ scores • C: Access only to own scores • O1: Usage Frequency • O2: CPR Technique – Calculated score (%) – Depth (mm) – Recoil (mm, %) – Rate (per minute) International Network for Simulation-based Pediatric Innovation, Research and Education PICO / Research Question
  20. 20. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions
  21. 21. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions Randomize Institutions
  22. 22. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions Randomize Institutions All Sites allow self-initiated CPR training using QCPR
  23. 23. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions Randomize Institutions All Sites allow self-initiated CPR training using QCPR Intervention Sites have access to scores from all participating institutions
  24. 24. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions Randomize Institutions All Sites allow self-initiated CPR training using QCPR Intervention Sites have access to scores from all participating institutions Control Sites only have access to individual score
  25. 25. 1. Healthcare Providers & Institutions with access to a Leaderboard increases the usage frequency of QCPR mannequins 2. Healthcare Providers & Institutions with access to a Leaderboard improves CPR technique as measured by the QCPR Score International Network for Simulation-based Pediatric Innovation, Research and Education Hypotheses
  26. 26. International Network for Simulation-based Pediatric Innovation, Research and Education Timeline ALERT Presentation 01.10.2015 IMSH 2015 Recruiting Sites 01 – 05.2015 Sites Pilot / Logistics 01 – 06.2015 Laerdal Foundation Grant due 04.15.2015 Other Grants too… Protocol Finalized 05.04.2015 IPSSW 2015 IRB Submissions 06.xx.2015 Data Collection 07.2015 – 06.2016 Depending on grants Interim Analysis 10.2015 – 12.2015 Depending on grants Update Meeting 01.xx.2016 IMSH 2016 Abstracts 04.2016 – 10.2016 IPSSW , etc. Manuscript(s) Winter 2016
  27. 27. 1. How to make / update Leaderboard? 2. Local rivalries or Int’l competition? 3. Other funding sources? International Network for Simulation-based Pediatric Innovation, Research and Education 3 questions to improve study
  28. 28. At INSPIRE @ IMSH 2015: 1. Recruit sites 2. Identify authorship, grants 3. Begin grantwriting & pilot phases In 2 months: 1. Prepare for IPSSW updates 2. Drafts of Grants & Pilot data analysis International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  29. 29. Todd P Chang, MD MAcM dr.toddchang@gmail.com http://www.inspiresim.com/ International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information
  30. 30. Progress Report Presentation: Development of simulation-based assessment tools for the general pediatrics milestones Leah Mallory, MD The Barbara Bush Children’s Hospital at Maine Medical Center IMSH 2015: New Orleans, LA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  31. 31. • For the 21 milestones sub-competencies, identify: 1. gaps in existing assessment tools and 2. best opportunities for simulation-based assessment • Where the 2 overlap, create and validate simulation-based assessment tools International Network for Simulation-based Pediatric Innovation, Research and Education Aim(s) - Revised
  32. 32. • August 2014- IRB exemption obtained for survey phase of project • September 2014- survey of pediatric simulation experts • October 2014- collaborate with APPD Simulation PEG to survey pediatric program directors through APPD • December 2015- from survey results, created “milestones-aligned wish list” for simulation-based assessment tools • January 2015- begin developing assessment tools in 3 prioritized areas • Spring 2015- present (IPSSW) and publish survey data pilot and continue to refine assessment tools • Summer/Fall 2015- establish reliability and validity of assessment tools across multiple sites International Network for Simulation-based Pediatric Innovation, Research and Education Timeline & Current progress
  33. 33. 1. Some of these areas/sub-competencies are difficult to assess, need to link observable, specific behaviors to be able to assess (e.g. insight into own strengths and weaknesses) 2. Possible to reliably distinguish between “novice” and “expert” in these categories? 3. In simulation setting, how to distinguish between individual and team performance? 4. How to create a practically useful assessment tool (not too long, not requiring extensive “train the trainer” input, that is also reliable and valid? International Network for Simulation-based Pediatric Innovation, Research and Education Needs / Challenges
  34. 34. At INSPIRE @ IMSH 2015: Use break-out group to develop first version of assessment tool for 3 identified areas In upcoming 3 months: Pilot and refine assessment tools Later 2015: Establish reliability and validity across multiple sites International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  35. 35. Name: Leah Mallory, MD Institution: The Barbara Bush Children’s Hospital at Maine Medical Center E-mail: mallol@mmc.org Phone: 207-662-1504 International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information
  36. 36. ALERT Presentation: Resuscitating Teamwork and Safety Using Acute Event Debriefing Michael-Alice Moga MD, Mary McBride MD, Genny Frey RN, Dana Schnasi MD, Walter Eppich MD, MEd Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Feinberg School of Medicine INSPIRE @ IMSH 2015 – New Orleans, LA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  37. 37. • ICU-based teamwork and safety culture remain suboptimal • Safety culture has been linked to patient outcomes • Outcomes after in-hospital pediatric cardiac arrest remain disappointing • From 2009-2014, only 38% of codes in our cardiac population possessed 6 elements of quality: – Teamwork: closed-loop communication, identified leader, noise control – Lack of technical errors, equipment malfunction, systems failure International Network for Simulation-based Pediatric Innovation, Research and Education Background
  38. 38. PICO / Research Question Patients suffering a cardiac arrest in the ICU Nurse-led, acute event debriefing Pre-intervention (?PICU) Teamwork, safety culture, code quality, patient outcomes P I C O International Network for Simulation-based Pediatric Innovation, Research and Education
  39. 39. International Network for Simulation-based Pediatric Innovation, Research and Education Approach / Design • Tool development • Train charge RNs in cardiac ICU • Test debriefing during in situ simulations Design/proof of concept • Integrate into current CQI with cold briefs • PDSA cycles Implement & integrate • Debrief Metrics: who, what, when, where, how • Code metrics: quality metrics, GWTG, outcomes • Unit-metrics: Safety / teamwork questionnaires • Dissemination: PICUICU RN-led debriefs of all housewide codes Evaluate ± expand
  40. 40. Current Continuous Quality Review 40 Code Data collection and entry 1. Real-time 2. Delayed chart review 3. Database entry Code Review Committee 1. Standardized presentation 2. QI discussion 3. Data entry-QI components Follow Up 1. Education 2. Team feedback 3. Quality Improvement Hotwash
  41. 41. • ALERT Presentation: January 2015 • Grant Proposal (if applicable): 2015/early 2016 • IRB Submission: March 2015 • Recruitment / Data Collection: April 2015 onwards for patients • Data Analysis: ongoing • Abstract Presentation: Concept/pilot-Fall 2015 • Manuscript Preparation: Concept/pilot-Fall 2015-2016 International Network for Simulation-based Pediatric Innovation, Research and Education Timeline
  42. 42. 1. What are pitfalls and barriers others have encountered with debriefing? 2. Best study design after proof of conceot/pilot 3. Are we covering a good range of outcomes? Too many, too few? International Network for Simulation-based Pediatric Innovation, Research and Education 3 questions to improve study
  43. 43. At INSPIRE @ IMSH 2015: -Network with others doing in situ debriefs -Feedback on tool, potential funding sources In 2 months: -Initial data for Capstone presentation -Have “proof of concept” with Tool, Training and Testing done International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  44. 44. Michael-Alice Moga, MD Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine mmoga@luriechildrens.org 312-227-1551 International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information
  45. 45. ALERT Presentation: The use of Leaderboards & Competition to improve High School CPR training Ralph J MacKinnon, MD Royal Manchester Children’s Hospital Todd P Chang, MD MAcM Children’s Hospital Los Angeles INSPIRE @ IMSH 2015 – New Orleans, LA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  46. 46. • Excellent School CPR programs exist globally base hospitals • Rolling self-initiated refreshers on CPR algorithms appear to improve skill (Kurosawa et al. 2014) • A clustering effect is seen when participants within a unit can compare CPR skill results using a Laerdal Q-CPR Mannequin (MacKinnon et al.) • Friendly competition appears to increase a la carte practice of CPR up to 3 months International Network for Simulation-based Pediatric Innovation, Research and Education Background
  47. 47. • P: High School • I: Access to Leaderboard & other teams & school’s scores • C: Participants – own controls • O1: Usage Frequency • O2: CPR Technique – Calculated score (%) – Depth (mm) – Recoil (mm, %) – Rate (per minute) International Network for Simulation-based Pediatric Innovation, Research and Education PICO / Research Question
  48. 48. 1. Competition sustains & promotes learning across school year 2. Access to a Leaderboard & QCPR mannequins improves CPR performance by high school pupils International Network for Simulation-based Pediatric Innovation, Research and Education Hypotheses
  49. 49. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit High Schools around Institutions
  50. 50. International Network for Simulation-based Pediatric Innovation, Research and Education Longitudinal cohort study Recruit Institutions Promote competition globally
  51. 51. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions Promote competition globally Baseline score capture
  52. 52. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions Promote competition globally Baseline score capture Weekly score upload
  53. 53. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions Promote competition globally Baseline score capture Weekly score upload Process engagement tracking
  54. 54. International Network for Simulation-based Pediatric Innovation, Research and Education Approach Recruit Institutions Promote competition globally Baseline score capture Weekly score upload Process engagement tracking Outcome measurement
  55. 55. International Network for Simulation-based Pediatric Innovation, Research and Education Timeline ALERT Presentation 01.10.2015 IMSH 2015 Recruiting Sites 11.2014 – 05.2015 Commenced Sites Pilot / Logistics 01 – 06.2015 Laerdal Foundation Grant due 04.15.2015 Other Grants too… Protocol Finalized 05.04.2015 IPSSW 2015 IRB Submissions 06.xx.2015 Data Collection 07.2015 – 06.2016 Depending on grants Interim Analysis 10.2015 – 12.2015 Depending on grants Update Meeting 01.xx.2016 IMSH 2016 Abstracts 04.2016 – 10.2016 IPSSW , etc. Manuscript(s) Winter 2016
  56. 56. 1. How to make / update Leaderboard? 2. Measurement of social media engagement? 3. Introduction of interventions over the year? International Network for Simulation-based Pediatric Innovation, Research and Education 3 questions to improve study
  57. 57. At INSPIRE @ IMSH 2015: 1. Recruit sites 2. Identify authorship, grants 3. Begin grant writing & pilot phases In 2 months: 1. Prepare for IPSSW updates 2. Drafts of Grants & Pilot data analysis International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  58. 58. Ralph MacKinnon Ralph.mackinnon@cmft.nhs.uk http://www.inspiresim.com/ International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information
  59. 59. Pediatric Simulation in Rural India: PedSRI Study Dr Sujatha Thyagarajan, Dr Rakshay Shetty Dr Geethanjali Ramachandra PediSTARS India INSPIRE @ IMSH 2015 – New Orleans, LA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  60. 60. • Simulation in Pediatrics is not an established method of training in India, though there is a felt need to inculcate it. • The utility to employ this method in a rural set-up is even more challenging. International Network for Simulation-based Pediatric Innovation, Research and Education Background
  61. 61. • P: Pediatric patients 1m to 16 years presenting to ER in a rural hospital and require transfer to a higher centre • I: Structured Simulation training programme to address recognition, stabilisation and transfer to a higher centre • C: Pre-intervention and post-intervention with the simulation training programme over a 6 months period each • O: Staff competence (?) and patient outcomes – LOS, mortality; International Network for Simulation-based Pediatric Innovation, Research and Education PICO / Research Question
  62. 62. • A pilot study of implementing a structured simulation programme for 4 most common pediatric emergencies seen in a rural set up was conducted by PediSTARS India in June 2014; • Many lessons learnt and encouraging enthusiasm by participants • Now a structured approach to study the impact w.r.t patient outcomes International Network for Simulation-based Pediatric Innovation, Research and Education Approach / Design
  63. 63. • ALERT Presentation - Jan 2015 • Grant Proposal (if applicable) • IRB Submission – Mar 2015 • Recruitment / Data Collection – May – Oct 2015 for pre- intervention data and post intervention Jan 2016 – June 2016 • Data Analysis – July 2016 – Aug 2016 • Abstract Presentation – Sep 2016 • Manuscript Preparation – Sep – Dec 2016 International Network for Simulation-based Pediatric Innovation, Research and Education Timeline
  64. 64. 1. What would be the best simulation programme structure? 2. What would be the best way to study the impact of simulation in a rural set up in India ? – sustainability is the key 3. What outcomes study will best reflect the utility of simulation in rural set up? International Network for Simulation-based Pediatric Innovation, Research and Education 3 questions to improve study
  65. 65. At INSPIRE @ IMSH 2015: Study details In 2 months: Research proposal, implementation and local support International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  66. 66. Name : Dr Sujatha Thyagarajan Institution: PediSTARS India E-mail, Phone: pedistars@gmail.com Website: www.pedistarsindia.com International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information

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