Here are 3 key questions the research group may want to consider: 1. Standardizing outcomes and assessments across sites while allowing for local flexibility. What core metrics and tools can be used consistently, while permitting some customization? 2. Developing a governance structure and processes that are inclusive yet efficient. How will decisions be made to balance needs of all members? 3. Determining authorship guidelines upfront to avoid future disputes. What qualifies someone as an author on multi-site studies? The group should discuss these issues early to facilitate collaborative work and trust within the network. Clear policies can help maximize the benefits of this innovative research model.

1. EpiPen:
How its use in Pediatric Hospital
Anaphylaxis May Impact Efficiency
and Patient Safety
Melinda Hamilton,Michael Rosen,
Nnenna Chime, Elizabeth Hunt

2. Background
• Anaphylaxis fatalities1
– Fatal food reactions, arrest within 30-35 min
– Insect stings, collapse from shock 10-15 min
– Deaths after IV medications occur within 5 min
• Errors with epinephrine administration
– Concentration of medication
– Dose of Medication
– Administration site
• Epinephrine Autoinjectors
– Concentration and dose guaranteed
– More timely
– Ease of use ??
1Pumphrey et al, Clin Exp Allerg 2000

3. PICO Question
• Population
– Pediatric code teams managing a simulated pediatric
anaphylaxis scenario
• Intervention
– Will the use of an epinephrine autoinjector device decrease
medication errors and decrease time to medication
administration during pediatric anaphylaxis
• Comparison
– compared with standard administration (med, syringe) of
epinephrine from a code cart
• Outcome
– Decrease medication errors (dose, concentration, site) and
decrease time to medication administration

4. Approach
• Several levels
1. Survey to children’s hospitals to understand their
anaphylaxis protocols
2. Simulation testing to define concerns (pilot)
1. Standard epi administration vs autoinjector
1. Evaluate time, dose, concentration
2. Note errors
3. Randomized controlled trial of simulated anaphylaxis
scenarios
1. Measure time to administration
2. Dose, concentration
3. Errors

5. 3 Questions
• What are children’s hospitals doing now?
• Can we understand how big of an issue this is in
pediatric hospitals?
• What portions should be conducted at multiple
centers ?

6. ALERT Presentation:
Improving neonatal resuscitation
using a virtual interactive trainer
Judy LeFlore, JoDee Anderson, Myra
Wyckoff, Taylor Sawyer, Lindsay Johnston,
Susan Niermeyer, Akira Nishisaki, Kathleen
Ventre, Marge Zielke

7. Background
• Airway management continues to be the leading
challenge to neonatal patient survival and safety because
endotracheal intubation skills are not easily taught.
• Proficiency in safe and successful endotracheal tube
placement improves with experience
• Inability to recognize key landmarks for successful
endotracheal intubation is the most significant failure
point.
• There is evidence that gaming and virtual reality in health
care education increases knowledge acquisition and
facilitates skill acquisition and transfer to clinical
practice.

8. PICO Question
• Population
– Healthcare providers that have newborn resuscitation
opportunities
• NNPs
• Pediatric residents
• Respiratory therapists
• Paramedics
• Intervention
– Neonatal Interactive Virtual Airway Trainer (NIVAT)
• Comparison
– Power point presentation
• Outcome
– Intubation success in the clinical setting will be
greater for the NIVAT intervention group than for the
PP intervention group

9. Approach
• 3-Phase study (Design over 3 years)
1. Phase I: Development Phase
1. Develop NIVAT, Proficiency assessment, PPT
2. Rater reliability
3. Recruit/randomize
1. Benchmark proficiency (#1)
2. Orient to intervention, study protocol, introduce journals
4. Participants keep journals during remainder of Dev Phase
2. Phase 2: Intervention Phase
1. Collect journals (#1)
2. Proficiency assessment (#2)
3. Intervention
3. Phase 3: Degradation Phase
1. Collect journals (#2)
2. Proficiency assessment (#3)
3. Data analysis

10. Develop Phase (1 year) Intervention Phase Begins
1. NIVAT 1. Collect journals (#1)
2. PPT 2. Proficiency assessment (#2)
3. Proficiency assessment tool 3. NIVAT or PPT Group
Intervention
4..Recruit
5. Randomize
6. Rater reliability
Decay Phase
7. Benchmark Proficiency (#1),
1. Collect journals (#2)
8.Orient to intervention, study
2. Proficiency assessment (#3)
protocol, and journal.
3. Data analysis
9 Study participants keep
journals during Development
Phase

11. 3 Questions
• HOW DO WE:
– To calculate adequately power for the study, what should be
used to calculate effect size?
– 30second from AAP
– Success on first or second try 80% of time?
– Where to recruit from now the GME no longer requires
intubation as a competency. Will program directors think this
study is important? How do we promote participants adherence
to monthly NIVAT or PPT. Should we try different exposure times
to assess “Dose effect”? Reliability of keeping accurate journals
r/t intubation opportunities throughout the study?
– Recruit research assistants committed to completing proficiency
assessments when indicated

13. The impact of tele-presence on
pediatric acute care in the
emergency department
Marc Auerbach, David Kessler, Adam Cheng,
Betsy Hunt, Noelle Zuckerbraun, Bob Dudas,
Lisa McQueen, John Lin, Vinay Nadkarni

14. Background
• Pediatric Emergency Care is “uneven”
– Pediatrics comprises 1/3 of ED visits
– 80% GED, 20% PED
• Telemedicine can improve access to specialists
– Radiology, cardiology, child abuse, trauma, stroke
– Tele-presence: real time participation in process
• Reduced mortality in adult ICUs
• Goal: optimal care whenever and
wherever children present

15. PICO Question
• Population
– Simulated critically ill pediatric patient in a standard ED setting
• Confederate/scripted RN, parents, ancillary staff
• Standard patient evolution
• Intervention
– GED attending + Tele-present specialist (PED, PICU)
• Comparison
– GED attending only, PED attending only
• Outcomes ?
– Improve time to interventions, adherence to guidelines
– Reduce errors

16. Project Aims
1. To characterize the differences in the process of
care for a simulated critically ill infant by
pediatric and general emergency medicine
physicians
1. To evaluate the impact of real-time tele-
presence of sub-specialty pediatric acute care
providers on the process of care for a simulated
critically ill infant

17. Approach
• Prospective simulation-based study
1 2 3
GED
PED GED
Tele

18. 3 Questions
1. What is the “ideal” case for this study?
2. What is our outcome variables and statistical
plans for this study? (primary and secondary)
– Time to interventions
– Adherence to PALS
– No flow fraction
– Errors
3. How do we train confederates as team
members to isolate provider cognitive
processes?

19. Objectives for 2.5 hours
• Create timeline for study
• Determine primary outcome, secondary
outcomes
• Design case scenario(s)
• Frame up an assessment instrument to pilot
• Assign projects to collaborators

20. NIPPERS Presentation:
National Inter Professional
Paediatric Education Research in
Simulation network (UK)
C. Bennett, K. Claydon-Smith, J. Cusack, D,
DeBeer, T. Everett, J.Fawke, S. Gough, D. Grant,
S.Hancock, S. Hanna, F. Horrox, A. Johnson, D.
Kerr, R. MacKinnon, W. Marriage, S. Newell, K.
Parkins, D. Rowney, A. Stevenson & P. Weir

21. Background
• Collaborative simulation research scarcity in UK
• ASPIH / IPSS
– Inter-professional UK network
– Vision: to answer local issues through well
formulated research
– Inaugural research group meeting 5th Feb 2012
• Identifiable Patient Impact Knowledge Gaps
– Trauma Team Outreach Educational Interventions
– Paediatric Palliative Care Packages
– In situ Paediatric Cardiac Arrest Team Performance
– Inter-professional Undergraduate Education

22. PICO Question
• Population
– In UK pediatric inter-professional teams
• Intervention
– will the use of a multi-site targeted simulation educational
interventions
• Comparison
– compared with no interventions
• Outcome
– improve direct clinical impact, team performance & translational
learning

23. Approach
• Mixed Methods Analysis
1. Development of standardised peer reviewed
educational interventions
2. Pilot studies of educational interventions
3. Assessment pre-introduction
4. Focus groups & targeted cohorts for educational
interventions
5. Quantitative & Qualitative assessment of impact on
patient care, team performance & translational
learning

24. 3 Questions
• Is there scope for international collaboration?
• What issues do we need to consider when
standardizing the research across study sites?
• How will the INSPIRE model function to address the
needs of national networks and single institution
members of part of INSPIRE network?