205 - Use of in-situ simulation to improve team performance and utilization of a rapid sequence intubation checklist

Poster Number: 205
Publication Number: 205.1799

Background: Intubation checklists have emerged as tools to reduce adverse events and improve efficiency during rapid sequence intubation (RSI) in pediatric emergency departments (PED). Simulation (SIM) based studies involving RSI checklists in the PED have not been fully explored despite positive results in pre-hospital and adult emergency medicine settings. PED-based SIM studies that do focus on the topic of RSI predominantly involve subjects of similar professional roles rather than a multidisciplinary approach.

Objective: This study aimed to use multidisciplinary simulation (SIM) training as an educational tool to improve pediatric ED team performance during RSI scenarios through utilization of an RSI checklist.

Design/Methods: We created a checklist modeled after previously published PED checklists. PED multidisciplinary teams (physicians, nurses, paramedics, medical technicians, and respiratory therapists) participated in video-recorded SIM training scenarios in which they manage an infant presenting in respiratory failure requiring intubation. Learners participated in the scenario 3 times: first without interruption, then again while receiving our intervention of rapid cycle deliberate practice (RCDP) debriefing focused on checklist utilization and team dynamics, and finally once more uninterrupted to apply the learned skills. Team performance was evaluated via video review using the Simulation Team Assessment Tool (STAT) focusing on airway management and human factors sections. Scores were compared before and after intervention. Pre- and post-intervention surveys were also collected.

Results: 483 learners participated in 64 SIM training sessions, 44 of which were reviewed by two reviewers each and included for data analysis. STAT scores increased post-intervention for airway management, human factors and overall. Total, airway and human factors scores mean differences were 84.1 (95% CI of 80.16-88.05), 42 (95% CI of 40.27-43.73) and 42.1 (95% CI of 39.42-44.78) pre-intervention vs 93.65 (95% CI of 89.7-97.59), 46.22 (95% CI of 44.49-47.94), and 47.43 (95% CI of 44.75-50.11) post-intervention, respectively with p-value < 0.001 across all categories. Surveys demonstrated improved role understanding and checklist utilization comfort post-intervention.

Conclusion(s): This study supports the benefit of multidisciplinary SIM training as an educational method for improving airway management, teamwork skills and RSI checklist utilization for PED staff.
RSI Fig 1.jpeg