INSPIRE @ IMSH 2015 ALERTs

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

• 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
Background

• 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)
PICO / Research Question

Approach / Design

• 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
Timeline

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”?
3 questions to improve study

At INSPIRE @ IMSH 2015:
Find collaborating centers
In 2 months: (hope) receive funding and
start pilots at lead site
Goals to accomplish

Dylan Bould
Children’s Hospital of Eastern Ontario,
University of Ottawa
dylanbould@gmail.com
Contact Information

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

• 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
Background

• 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

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
Debrief
Intervention
Pediatric Cardiac Arrest Scenario
With VisF
Collect data on CPR
Debrief with summative feedback
Pediatric Cardiac Arrest Scenario #2
Collect data on CPR
Debrief with summative feedback

• 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
Timeline

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?

 Refine/optimize research protocol
 Input from group
In 2 months: Complete grant applications
Goals to accomplish

Linda L. Brown, MD MSCE
Alpert Medical School of Brown
University/Hasbro Children’s Hospital
lbrown8@lifespan.org
401-444-6237
Contact Information

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

• 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
Background

• 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)

Approach
Recruit
Institutions

Approach
Recruit
Institutions
Randomize
Institutions

Approach
Recruit
Institutions
Randomize
Institutions
All Sites allow self-initiated
CPR training using QCPR

Approach
Recruit
Institutions
Randomize
Institutions
Intervention Sites have
access to scores from all
participating institutions

Approach
Recruit
Institutions
Randomize
Institutions
Intervention Sites have
access to scores from all
participating institutions
Control Sites only have
access to individual score

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
Hypotheses

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

1. How to make / update Leaderboard?
2. Local rivalries or Int’l competition?
3. Other funding sources?

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
Goals to accomplish

Todd P Chang, MD MAcM
dr.toddchang@gmail.com
http://www.inspiresim.com/
Contact Information

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

• 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
Aim(s) - Revised

• 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
Timeline & Current progress

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?
Needs / Challenges

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
Goals to accomplish

Name: Leah Mallory, MD
Institution: The Barbara Bush Children’s
Hospital at Maine Medical Center
E-mail: mallol@mmc.org
Phone: 207-662-1504
Contact Information

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

• 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
Background

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

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

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

• 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
Timeline

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?

-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
Goals to accomplish

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
Contact Information

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

• 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
Background

• 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)

1. Competition sustains & promotes learning across school
year
2. Access to a Leaderboard & QCPR mannequins improves
CPR performance by high school pupils
Hypotheses

Approach
Recruit High
Schools around
Institutions

Longitudinal cohort study
Recruit
Institutions
Promote
competition
globally

Approach
Recruit
Institutions
Promote
competition
globally
Baseline score capture

Approach
Recruit
Institutions
Promote
competition
globally
Weekly score upload

Approach
Recruit
Institutions
Promote
competition
globally
Weekly score upload
Process engagement tracking

Approach
Recruit
Institutions
Promote
competition
globally
Weekly score upload
Process engagement tracking
Outcome measurement

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

1. How to make / update Leaderboard?
2. Measurement of social media
engagement?
3. Introduction of interventions over the
year?

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
Goals to accomplish

Ralph MacKinnon
Ralph.mackinnon@cmft.nhs.uk
http://www.inspiresim.com/
Contact Information

Pediatric Simulation in Rural
India: PedSRI Study
Dr Sujatha Thyagarajan,
Dr Rakshay Shetty
Dr Geethanjali Ramachandra
PediSTARS India

• 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.
Background

• 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;

• 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
Approach / Design

• 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
Timeline

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?

At INSPIRE @ IMSH 2015: Study details
In 2 months: Research proposal,
implementation and local support
Goals to accomplish

Name : Dr Sujatha Thyagarajan
Institution: PediSTARS India
E-mail, Phone: pedistars@gmail.com
Website: www.pedistarsindia.com
Contact Information

INSPIRE @ IMSH 2015 ALERTs

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