TOP 17 - Practice the PIVOT (Pediatric Inpatient Vigilance Improves Outcomes & Training): Low-cost simulation to improve inpatient pediatric unit response to the acutely deteriorating child

Publication Number: 1777.TOP 17

Nashid H.. Chaudhury, Yale-New Haven Children's Hospital, New Haven, CT, United States; Sandy Maione, Yale-New Haven Children's Hospital, New Haven, CT, United States; Becca Mielke, Improving Pediatric Acute Care Through Simulation (ImPACTS), Round Rock, TX, United States; Daniela Hochreiter, Yale School of Medicine, New Haven, CT, United States; Marc Auerbach, Yale School of Medicine, Milford, CT, United States

Background: Most pediatric hospitalizations occur in general hospitals without immediate access to pediatric emergency or intensive care. Even at specialized centers, unrecognized clinical deterioration on general units lead to increased health care costs, length of stay, morbidity, and mortality. Difficulty recognizing deterioration has led to an over-reliance on the rapid response team for non-critical concerns. This overuse strains resources and erodes patient confidence in hospitalist care. The etiology includes decreased staff experience (post-pandemic turnover), increased medical complexity, and poor system preparedness. Instead of reactive changes after adverse safety events, we must focus on proactive tools for these low-frequency, high-stake events to prevent harm. There is an unmet need for a low-cost tool for the general pediatric unit to improve system response, reduce critical care over-utilization, and identify latent safety events (LSEs).

Objective: We investigated whether low-cost, inter-professional simulation can improve inpatient pediatric response to the acutely deteriorating child, through quality and safety outcomes. Our primary objective assesses the effectiveness and feasibility of using 'Simbox' cases modified for the inpatient pediatric unit to this end. Our secondary objective explores if this low-cost tool can detect LSEs and improve quality and patient safety.

Design/Methods: Our study uses a type 3 hybrid effectiveness-implementation design and was deemed exempt by our IRB. We performed an interdisciplinary needs assessment to modify five 'Simbox' cases for the inpatient floor: sepsis, status epilepticus, status asthmaticus, anaphylaxis, and supraventricular tachycardia. In-situ simulations were performed 3x/month across 3 units over 10 months, totaling 30 sessions (120 participants). On-service staff (2 nurses, 2 residents) participated in their normal roles. Sessions lasted 30 minutes and were co-led by a physician and nurse. Process measures collected included: unit, date, time, facilitators, participants, and cancellation rates. Retrospective pre-post surveys assessed acceptability, appropriateness, feasibility, net promoter score, and knowledge (5-point Likert scale). Our primary analysis will compare pre- vs. post-simulation assessments and examine trends. LSEs were identified by co-facilitators during each simulation and reported to our institutional safety system for review. Our secondary analysis will examine LSE number, categories, and outcomes via a statistical process control chart. All data has been collected; analysis will be complete by 1/31/2026.

Graphical abstract for study method and objectives
Simbox cases were contextualized to the general inpatient setting, in situ simulations were performed across 3 units, and process and outcome measures were collected for analyses