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New ALERT - Improving Pediatric Acute Care in Community EDs through Collaborative Simulation

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Whitfill T (Yale), Katznelson J, Auerbach M

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New ALERT - Improving Pediatric Acute Care in Community EDs through Collaborative Simulation

  1. 1. Improving Pediatric Acute Care in Community EDs through Collaborative Simulation Marc Auerbach, Jessica Katznelson, Travis Whitfill Yale University INSPIRE @ IMSH 2016 – San Diego, CA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  2. 2. • The National Pediatric Readiness Project recommends that all EDs have a Pediatric Emergency Care Coordinator (PECC), broadly defined as an individual “assigned the role of overseeing various administrative aspects of pediatric emergency care.” – However, the effect of PECC on quality metrics has not been described. • Our team has completed a multi-year research project involving 172 standardized in-situ simulations to rigorously measure the resuscitative care delivered to critically ill children in 22 community EDs. – This project provides elucidated areas for improvement at both the provider and the systems level. This proposal is to leverage these findings to serve as a needs assessment to inform the development of an effective low cost pediatric resuscitation improvement program (PRIP) compared to PECC alone International Network for Simulation-based Pediatric Innovation, Research and Education Background
  3. 3. • P: General Emergency Departments (GEDs) • I/C: – Intervention: Modular pediatric resuscitation improvement program (PRIP) – Control: Pediatric care coordinator alone • O: Composite quality score (CQS) for pediatric resuscitation International Network for Simulation-based Pediatric Innovation, Research and Education PICO / Research Question
  4. 4. The specific aims of this cluster randomized cross over trial are as follows: (1) To develop a modular pediatric resuscitation improvement program (PRIP) that can be delivered by PECCs through an established consortium of community EDs and Children’s Hospitals. (2) To implement PRIP at 12 community ED sites (3) To measure the efficacy of the PRIP over time utilizing a) In-situ simulation-based assessments in each ED c) Implicit review scores for actual pediatric cases in each ED d) Pediatric Readiness Survey Scores of each ED (4) To compare the changes in measures at sites completing PRIP modules compared to control sites with a self-directed PECC International Network for Simulation-based Pediatric Innovation, Research and Education Specific aims
  5. 5. • Recruitment – 7 Pediatric EDs, including 2 lead hospitals at Yale (PI: Auerbach) and Hopkins (PI: Katznelson) – Each pediatric ED will enroll 1 GED • Study design – Prospective, cluster-randomized, quasi-crossover, multi-center study – Control crosses over to intervention midway • Data capture – Composite quality score • Performance on cardiac arrest, seizure, and septic shock • Teamwork • *Pilot data from 30 sites • Data analysis – PRIP vs. PECC – Pre-vs. post International Network for Simulation-based Pediatric Innovation, Research and Education Approach / Design
  6. 6. International Network for Simulation-based Pediatric Innovation, Research and Education Study design schematic
  7. 7. • ALERT Presentation • Grant submission: February 2016 • IRB Submission: August 2016 • Recruitment: September – December 2016 • Randomization, study initiation, initial assessments: January-March 2017 • Repeat assessment 1: November 2017 • Crossover: November 2017 • Repeat assessment 2: September 2018 • Data analysis, manuscript preparations: September-December 2018 International Network for Simulation-based Pediatric Innovation, Research and Education Timeline
  8. 8. 1. What are meaningful secondary outcomes that could capture patient outcomes (most likely as pilot data)? 2. Any improvements in study design? 3. Feasibility issues? International Network for Simulation-based Pediatric Innovation, Research and Education 3 questions to improve study
  9. 9. At INSPIRE @ IMSH 2016: Receive feedback Solidify plan and study design In 2 months: Apply for EMSC targeted issues grant in February International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  10. 10. Name: Travis Whitfill Institution: Yale University E-mail: travis.whitfill@yale.edu Phone: 817-319-4417 International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information

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