178 - Effectiveness of Iterative Practice in Pediatric Simulation at a Community Hospital

Publication Number: 3171.178

Azadeh Fayazi, Stanford University School of Medicine, Milpitas, CA, United States; Siobhan Hopkins, Stanford University School of Medicine, Walnut Creek, CA, United States

Background: Simulation training is an essential part of ongoing medical education for practicing healthcare professionals. Cardiac arrest among children is rare and requires expertise in Pediatric Advanced Life Support and teamwork. Iterative simulation practice can provide a more optimal educational opportunity in community hospitals to ensure knowledge and skill acquisition in pediatric resuscitation by practicing healthcare professionals.

Objective: The goal of this study was to improve knowledge and teamwork within a limited simulation period. We hypothesized that implementing iterative practice will increase pediatric resuscitation knowledge and specific team behaviors by 10%.

Design/Methods: We implemented an in situ multidisciplinary, high-fidelity simulation curriculum, where the scenario was repeated to allow for improvement. This prospective study tracked improvements through three multiple choice surveys: pre-simulation, post-simulation 1, and post-simulation 2. Data collected over two years were analyzed using McNemar's test to compare paired binary variables and Wilcoxon signed rank test to compare paired ordinal variables.

Results: A total of 99 surveys were completed by 27 pediatric nurses, 24 pediatric intensive care nurses, 4 pediatric intensivists, 18 pediatric hospitalists, 15 respiratory therapists, 8 pharmacists, and 1 non-pediatric staff member. Knowledge of indications for cardiopulmonary resuscitation in children improved by 12% (73% vs. 85%, P = .008) and that of chest compression (CC) to ventilation ratio in adolescents increased by 16% (64% vs. 80%, P = .005). Understanding of CC to ventilation ratio in children improved by 11% (79% vs. 90%, P=.027) and that of ventilation with an advanced airway increased after both simulations by 22% (53% vs. 75%, P <.001), then by 13% (75% vs. 88%, P = .004). Statistically significant improvements were not observed for choosing the correct shockable rhythms. All team behaviors improved: information was "always" received by 80% of participants and increased to 93% (P <.001); self-identification improved from 65% of participants to 86% (P <.001); and leader identification was noted by 78% of participants and increased to 93% (P <.001).

Conclusion(s): Iterative simulation practice effectively enhances knowledge and pediatric resuscitation team performance in community hospitals. Future research should explore the simulation frequency needed to retain these knowledge and skills.

Figure 1. Iterative Practice Session Timeline


Figure 2. Correct responses in pre-simulation (Pre Sim), post-simulation 1 (Post Sim 1), and post-simulation 2 (Post Sim 2) surveys.
* Statistically significant change compared to previous survey. CPR = cardiopulmonary resuscitation, Vent = ventilation, CC = chest compressions

Figure 3. Responses to team behavior questions in post-simulation 1 (Post Sim 1) and post-simulation 2 (Post Sim 2)
* Statistically significant change compared to previous survey.