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Corazza F, Stritoni V, Martinolli F, Daverio M, Binotti M, Genoni G, Ingrassia PL, De Luca M, Palmas G, Maccora I, Frigo AC, Da Dalt L, Bressan S. Adherence to guideline recommendations in the management of pediatric cardiac arrest: a multicentre observational simulation-based study. Eur J Emerg Med 2022; 29:271-278. [PMID: 35404331 PMCID: PMC10878464 DOI: 10.1097/mej.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND IMPORTANCE Pediatric cardiac arrest is a rare emergency with associated high mortality. Its management is challenging and deviations from guidelines can affect clinical outcomes. OBJECTIVES To evaluate the adherence to guideline recommendations in the management of a pediatric cardiac arrest scenario by teams of pediatric residents. Secondarily, the association between the use of the Pediatric Advanced Life Support-2015 (PALS-2015) pocket card, and the teams' adherence to international guidelines, were explored. DESIGN, SETTINGS AND PARTICIPANTS Multicentre observational simulation-based study at three Italian University Hospitals in 2018, including PALS-2015 certified pediatric residents in their 3rd-5th year of residency program, divided in teams of three. INTERVENTION OR EXPOSURE Each team conducted a standard nonshockable pediatric cardiac arrest scenario and independently decided whether to use the PALS-2015 pocket card. OUTCOME MEASURE AND ANALYSIS The primary outcome was the overall number and frequency of individual deviations from the PALS-2015 guidelines, measured by the novel c-DEV15plus score (range 0-15). Secondarily, the performance on the validated Clinical Performance Tool for asystole scenarios, the time to perform resuscitation tasks and cardiopulmonary resuscitation (CPR) quality metrics were compared between the teams that used and did not use the PALS-2015 pocket card. MAIN RESULTS Twenty-seven teams (81 residents) were included. Overall, the median number of deviations per scenario was 7 out of 15 [interquartile range (IQR), 6-8]. The most frequent deviations were delays in positioning of a CPR board (92.6%), calling for adrenaline (92.6%), calling for help (88.9%) and incorrect/delayed administration of adrenaline (88.9%). The median Clinical Performance Tool score was 9 out of 13 (IQR, 7-10). The comparison between teams that used ( n = 13) and did not use ( n = 14) the PALS-2015 pocket card showed only significantly higher Clinical Performance Tool scores in the former group [9 (IQR 9-10) vs. 7 (IQR 6-8); P = 0.002]. CONCLUSIONS Deviations from guidelines, although measured by means of a nonvalidated tool, were frequent in the management of a pediatric cardiac arrest scenario by pediatric residents. The use of the PALS-2015 pocket card was associated with better Clinical Performance Tool scores but was not associated with less deviations or shorter times to resuscitation tasks.
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Affiliation(s)
- Francesco Corazza
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Valentina Stritoni
- Department of Woman’s and Child’s Health, Paediatric Intensive Care Unit, University of Padua, Padua
| | - Francesco Martinolli
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Marco Daverio
- Department of Woman’s and Child’s Health, Paediatric Intensive Care Unit, University of Padua, Padua
| | - Marco Binotti
- Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità University Hospital, University of Piemonte Orientale, Novara, Italy
| | - Giulia Genoni
- Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità University Hospital, University of Piemonte Orientale, Novara, Italy
| | - Pier Luigi Ingrassia
- Centro di Simulazione (CeSi), Centro Professionale Sociosanitario di Lugano, Lugano, Switzerland
| | - Marco De Luca
- Paediatric Simulation Centre, Meyer Children’s University Hospital
| | - Giordano Palmas
- Department of Health Sciences, University of Florence and Meyer Children’s University Hospital, Florence
| | - Ilaria Maccora
- Department of Health Sciences, University of Florence and Meyer Children’s University Hospital, Florence
| | - Anna Chiara Frigo
- Department of Cardiac, Biostatistics, Epidemiology and Public Health Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Silvia Bressan
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
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2
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Peltan ID, Guidry D, Brown K, Kumar N, Beninati W, Brown SM. Telemedical Intensivist Consultation During In-Hospital Cardiac Arrest Resuscitation: A Simulation-Based, Randomized Controlled Trial. Chest 2022; 162:111-119. [PMID: 35063451 DOI: 10.1016/j.chest.2022.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High-quality leadership improves resuscitation for in-hospital cardiac arrest (IHCA), but experienced resuscitation leaders are unavailable in many settings. RESEARCH QUESTION Does real-time telemedical intensivist consultation improve resuscitation quality for IHCA? STUDY DESIGN AND METHODS In this multicenter randomized controlled trial, standardized high-fidelity simulations of IHCA conducted between February 2017 and September 2018 on inpatient medicine and surgery units at seven hospitals were assigned randomly to consultation (intervention) or simulated observation (control) by a critical care physician via telemedicine. The primary outcome was the fraction of time without chest compressions (ie, no-flow fraction) during an approximately 4- to 6-min analysis window beginning with telemedicine activation. Secondary outcomes included other measures of chest compression quality, defibrillation and medication timing, resuscitation protocol adherence, nontechnical team performance, and participants' experience during resuscitation participation. RESULTS No-flow fraction did not differ between the 36 intervention group (0.22 ± 0.13) and the 35 control group (0.19 ± 0.10) resuscitation simulations included in the intention-to-treat analysis (P = .41). The etiology of the simulated cardiac arrest was identified more often during evaluable resuscitations supported by a telemedical intensivist consultant (22/32 [69%]) compared with control resuscitations (10/34 [29%]; P = .001), but other measures of resuscitation quality, resuscitation team performance, and participant experience did not differ between intervention groups. Problems with audio quality or the telemedicine connection affected 14 intervention group resuscitations (39%). INTERPRETATION Consultation by a telemedical intensivist physician did not improve resuscitation quality during simulated ward-based IHCA. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03000829; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Ithan D Peltan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT.
| | - David Guidry
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT
| | - Katie Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT
| | - Naresh Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT
| | - William Beninati
- Telehealth Program, Intermountain Healthcare, Salt Lake City, UT; Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT
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3
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Schoen JC, Russi CS, Laack TA. Addressing Barriers to Telemedicine Use in Rural Emergency Medicine: Leveraging In Situ Simulation. Telemed J E Health 2021; 28:276-281. [PMID: 33872089 DOI: 10.1089/tmj.2021.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Acute care telemedicine is a critical resource for rural and community Emergency Medicine (EM) providers. To address potential barriers and promote use of these services throughout our health system Emergency Departments (EDs), we embed telemedicine consultations within in situ simulations. Methods: Care teams in health system EDs participated in multidisciplinary in situ simulations that focused on Difficult Airway management or Obstetric Emergencies. Physicians in EM and Neonatology at the referral center were available for assistance via telemedicine consultation. Participants were then surveyed regarding their experience with the telemedicine consultation during the simulations. Results: Participants reported increased likelihood to use telemedicine as well as increased understanding of the technology, awareness of available consultation services, and comfort interacting with the consultant. Conclusions: Embedding telemedicine consultations into in situ EM simulations is an effective approach to address implementation barriers and may promote increased use of telemedicine services among rural and community EM providers.
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Affiliation(s)
- Jessica C Schoen
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Emergency Medicine, Mayo Clinic Health System Albert Lea and Austin, Austin, Minnesota, USA.,Mayo Clinic Multidisciplinary Simulation Center, Rochester, Minnesota, USA
| | | | - Torrey A Laack
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Mayo Clinic Multidisciplinary Simulation Center, Rochester, Minnesota, USA
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Brei BK, Neches S, Gray MM, Handley S, Castera M, Hedstrom A, D'Cruz R, Kolnik S, Strandjord T, Mietzsch U, Cooper C, Moore JM, Billimoria Z, Sawyer T, Umoren R. Telehealth Training During the COVID-19 Pandemic: A Feasibility Study of Large Group Multiplatform Telesimulation Training. Telemed J E Health 2020; 27:1166-1173. [PMID: 33395364 DOI: 10.1089/tmj.2020.0357] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Video telehealth is an important tool for health care delivery during the COVID-19 pandemic. Given physical distancing recommendations, access to traditional in-person telehealth training for providers has been limited. Telesimulation is an alternative to in-person telehealth training. Telesimulation training with both remote participants and facilitators using telehealth software has not been described. Objective: We investigated the feasibility of a large group telesimulation provider training of telehealth software for remote team leadership skills with common neonatal cases and procedures. Methods: We conducted a 90-min telesimulation session with a combination of InTouch™ provider access software and Zoom™ teleconferencing software. Zoom facilitators activated InTouch software and devices and shared their screen with remote participants. Participants rotated through skill stations and case scenarios through Zoom and directed bedside facilitators to perform simulated tasks using the shared screen and audio connection. Participants engaged in a debrief and a pre- and postsurvey assessing participants' comfort and readiness to use telemedicine. Data were analyzed using descriptive statistics and paired t tests. Results: Twenty (n = 20) participants, five Zoom and eight bedside facilitators participated. Twenty-one (21) pre- and 16 postsurveys were completed. Most participants were attending neonatologists who rarely used telemedicine software. Postsession, participants reported increased comfort with some advanced InTouch features, including taking and sharing pictures with the patient (p < 0.01) and drawing on the shared image (p < 0.05), but less comfort with troubleshooting technical issues, including audio and stethoscope (p < 0.01). Frequently stated concerns were troubleshooting technical issues during a call (75%, n = 16) and personal discomfort with telemedicine applications and technology (56%, n = 16). Conclusion: Large group telesimulation is a feasible way to offer telehealth training for physicians and can increase provider comfort with telehealth software.
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Affiliation(s)
- Brianna K Brei
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neonatology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sara Neches
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Sarah Handley
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Mark Castera
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Anna Hedstrom
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Ravi D'Cruz
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Sarah Kolnik
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Thomas Strandjord
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Ulrike Mietzsch
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Christine Cooper
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Jami M Moore
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Zeenia Billimoria
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Taylor Sawyer
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Moguilner S, Pandya S, Schroeder S, Banach M, Ray D. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health 2020; 8:410. [PMID: 33014958 PMCID: PMC7505101 DOI: 10.3389/fpubh.2020.00410] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia.,Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Alberta Health Services and Project PoSSUM, University of Alberta, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.,Department of Hypertension, Medical University of Lodz, Łódz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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Fortier MA, Yang S, Phan MT, Tomaszewski DM, Jenkins BN, Kain ZN. Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities. Pediatr Blood Cancer 2020; 67:e28124. [PMID: 31850674 PMCID: PMC8266302 DOI: 10.1002/pbc.28124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first-line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.
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Affiliation(s)
- Michelle A. Fortier
- UCI Center on Stress and Health, School of Medicine, University of California, California, Irvine,Sue and Bill Gross School of Nursing, University of California, California, Irvine,Department of Anesthesiology and Perioperative Care, University of California, California, Irvine,Department of Pediatric Psychology, Children’s Hospital of Orange County, California, Orange
| | - Sun Yang
- School of Pharmacy, Chapman University, California, Orange
| | | | | | - Brooke N. Jenkins
- UCI Center on Stress and Health, School of Medicine, University of California, California, Irvine,Department of Psychology, Chapman University, California, Orange
| | - Zeev N. Kain
- UCI Center on Stress and Health, School of Medicine, University of California, California, Irvine,Department of Anesthesiology and Perioperative Care, University of California, California, Irvine,Child Study Center, Yale University, New Haven, Connecticut,American College of Perioperative Medicine, California, Irvine
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Binkhorst M, van de Wiel I, Draaisma JMT, van Heijst AFJ, Antonius T, Hogeveen M. Neonatal resuscitation guideline adherence: simulation study and framework for improvement. Eur J Pediatr 2020; 179:1813-1822. [PMID: 32472265 PMCID: PMC7547969 DOI: 10.1007/s00431-020-03693-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/17/2020] [Accepted: 05/16/2020] [Indexed: 11/25/2022]
Abstract
We wanted to assess newborn life support (NLS) knowledge and guideline adherence, and provide strategies to improve (neonatal) resuscitation guideline adherence. Pediatricians completed 17 multiple-choice questions (MCQ). They performed a simulated NLS scenario, using a high-fidelity manikin. The literature was systematically searched for publications regarding guideline adherence. Forty-six pediatricians participated: 45 completed the MCQ, 34 performed the scenario. Seventy-one percent (median, IQR 56-82) of the MCQ were answered correctly. Fifty-six percent performed inflation breaths ≤ 60 s, 24% delivered inflation breaths of 2-3 s, and 85% used adequate inspiratory pressures. Airway patency was ensured 83% (IQR 76-92) of the time. Median events/min, compression rate, and percentage of effective compressions were 138/min (IQR 130-145), 120/min (IQR 114-120), and 38% (IQR 24-48), respectively. Other adherence percentages were temperature management 50%, auscultation of initial heart rate 100%, pulse oximeter use 94%, oxygen increase 74%, and correct epinephrine dose 82%. Ten publications were identified and used for our framework. The framework may inspire clinicians, educators, researchers, and guideline developers in their attempt to improve resuscitation guideline adherence. It contains many feasible strategies to enhance professionals' knowledge, skills, self-efficacy, and team performance, as well as recommendations regarding equipment, environment, and guideline development/dissemination.Conclusion: NLS guideline adherence among pediatricians needs improvement. Our framework is meant to promote resuscitation guideline adherence. What is Known: • Inadequate newborn life support (NLS) may contribute to (long-term) pulmonary and cerebral damage. • Video-based assessment of neonatal resuscitations has shown that deviations from the NLS guideline occur frequently; this assessment method has its audiovisual shortcomings. What is New: • The resuscitation quality metrics provided by our high-fidelity manikin suggest that the adherence of Dutch general pediatricians to the NLS guideline is suboptimal. • We constructed a comprehensive framework, containing multiple strategies to improve (neonatal) resuscitation guideline adherence.
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Affiliation(s)
- Mathijs Binkhorst
- Department of Neonatology, Amalia Children's Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Irene van de Wiel
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos M. T. Draaisma
- Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arno F. J. van Heijst
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Tim Antonius
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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Gross IT, Whitfill T, Redmond B, Couturier K, Bhatnagar A, Joseph M, Joseph D, Ray J, Wagner M, Auerbach M. Comparison of Two Telemedicine Delivery Modes for Neonatal Resuscitation Support: A Simulation-Based Randomized Trial. Neonatology 2020; 117:159-166. [PMID: 31905354 DOI: 10.1159/000504853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous research has described technical aspects of telemedicine and the clinical impact of provider-to-patient telemedicine; however, little is known about provider-to-provider telemedical interventions. OBJECTIVE The primary aim of this study was to compare two telemedicine delivery modes on the quality of a simulated neonatal resuscitation. Our secondary aim was to evaluate the providers' task load. METHODS This was a prospective, single-center, randomized, simulation-based trial comparing a remote neonatal team leader ("teleleader") versus a remote consultant ("teleconsultant"). Participants resuscitated a simulated, apneic, and bradycardic neonate. Performance was assessed by video review and task load was measured by the self-reported NASA task load index (NASA-TLX) tool. In the teleleader group, one remote neonatal specialist assumed the role of team leader in the resuscitation. In the teleconsultant group, the same remote specialist assumed the role of teleconsultant. RESULTS Twenty-two participants were included in the analyses. The teleleader group was associated with a higher overall checklist score compared to teleconsultants (median score 68%, interquartile range [IQR]: 66-69 vs. 58%, IQR: 42-62; p = 0.016). No significant difference was seen in overall subjective workload as measured by the NASA-TLX tool. However, mental demand and frustration were significantly greater with teleconsultants compared to teleleaders (mean mental demand: 14.1 vs. 17.0 out of 21; frustration: 7.9 vs. 14.7 out of 21). CONCLUSIONS Simulated neonates randomized to teams with teleleaders received significantly better resuscitative care compared to those randomized to teams with teleconsultants. Mental demand and frustration were higher for providers in the teleconsultant compared to teleleader teams.
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Affiliation(s)
- Isabel T Gross
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA,
| | - Travis Whitfill
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brooke Redmond
- Department of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katherine Couturier
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambika Bhatnagar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melissa Joseph
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Joseph
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jessica Ray
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Marc Auerbach
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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9
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Couturier K, Whitfill T, Bhatnagar A, Panchal RA, Parker J, Wong AH, Bruno CJ, Auerbach MA, Gross IT. Impact of telemedicine on neonatal resuscitation in the emergency department: a simulation-based randomised trial. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2019; 6:10-14. [PMID: 35514445 DOI: 10.1136/bmjstel-2018-000398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2018] [Indexed: 11/04/2022]
Abstract
Background The delivery and initial resuscitation of a newborn infant are required but rarely practised skills in emergency medicine. Deliveries in the emergency department are high-risk events and deviations from best practices are associated with poor outcomes. Introduction Telemedicine can provide emergency medicine providers real-time access to a Neonatal Resuscitation Program (NRP)-trained paediatric specialist. We hypothesised that adherence to NRP guidelines would be higher for participants with access to a remotely located NRP-trained paediatric specialist via telemedicine compared with participants without access. Materials and methods Prospective single-centre randomised trial. Emergency Medicine residents were randomised into a telemedicine or standard care group. The participants resuscitated a simulated, apnoeic and bradycardic neonate. In the telemedicine group a remote paediatric specialist participated in the resuscitation. Simulations were video recorded and assessed for adherence to guidelines using four critical actions. The secondary outcome of task load was measured through participants' completion of the NASA Task Load Index (NASA-TLX) and reviewers completed a detailed NRP checklist. Results Twelve participants were included. The use of telemedicine was associated with significantly improved adherence to three of the four critical actions reflecting NRP guidelines as well as a significant improvement in the overall score (p<0.001). On the NASA-TLX, no significant difference was seen in overall subjective workload assessment, but of the subscore components, frustration was statistically significantly greater in the control group (p<0.001). Conclusions In this study, telemedicine improved adherence to NRP guidelines. Future work is needed to replicate these findings in the clinical environment.
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Affiliation(s)
- Katherine Couturier
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Travis Whitfill
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambika Bhatnagar
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rajavee A Panchal
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Parker
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christie J Bruno
- Department of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marc A Auerbach
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isabel T Gross
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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10
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Leary JC, Walsh KE, Morin RA, Schainker EG, Leyenaar JK. Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review. J Hosp Med 2019; 14:694-703. [PMID: 31532739 PMCID: PMC6827538 DOI: 10.12788/jhm.3268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the majority of children are hospitalized in nonchildren's hospitals, little is known about the quality and safety of pediatric care in community hospitals. OBJECTIVE The aim of this study was to conduct a scoping review and synthesize literature on the quality and safety of pediatric inpatient care in United States community hospitals. METHODS We performed a systematic literature search in October 2016 to identify pediatric studies that reported on safety, effectiveness, efficiency, timeliness, patient-centeredness, or equity set in general, nonuniversity, or nonchildren's hospitals. We extracted data on study design, patient descriptors, and quality outcomes and assessed the risk of bias using modified Newcastle-Ottawa Scales. RESULTS A total of 44 articles met the inclusion criteria. Study designs, patient populations, and quality outcome measures were heterogeneous; only three clinical domains, (1) perinatal regionalization, (2) telemedicine, and (3) imaging radiation, were explored in multiple studies with consistent directionality of results. A total of 30 studies were observational, and 22 studies compared community hospital quality outcomes with other hospital types. The remaining 14 studies reported testing of interventions; 12 showed improved quality of care postintervention. All studies reported an outcome addressing safety, effectiveness, or efficiency, whereas timeliness, patient-centeredness, and equity were infrequently addressed. Risk of bias was moderate or high for 72% of studies. CONCLUSIONS Literature on the inpatient care of children in community hospitals is limited, making it difficult to evaluate healthcare quality. Measures of timeliness, patient-centeredness, and equity are underrepresented. The field would benefit from more multicenter collaborations to facilitate the application of robust study designs and to enable a systematic assessment of individual interventions and community hospital quality outcomes.
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Affiliation(s)
- Jana C Leary
- The Floating Hospital for Children at Tufts Medical Center, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
- Corresponding Author: Jana C. Leary, MD, MS; E-mail: ; Telephone: 617-636-4624
| | - Kathleen E Walsh
- James M Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Rebecca A Morin
- Tufts University, Hirsh Health Sciences Library, Boston, Massachusetts
| | | | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice and Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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11
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Chuo J, Webster KA. Practical use of telemedicine in the chronically ventilated infant. Semin Fetal Neonatal Med 2019; 24:101036. [PMID: 31727571 DOI: 10.1016/j.siny.2019.101036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Telemedicine, or the use of electronic communication technology to improve patient health, is becoming more widely adopted as a means of bringing together patients, providers and family members to facilitate evaluation, monitoring, diagnosis and treatment. A particularly vulnerable group consists of children with dependence on technology, such as chronic mechanical ventilation. This chapter will provide an overview of how telehealth technology is currently being used, for supporting this patient population through 1) inpatient support 2) integration with the medical home 3) bridging care transitions 4) remote patient management and 5) multispecialty consultations. We will also discuss the impact on quality and cost, the current research environment and practical points for implementation into clinical practice.
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Affiliation(s)
- John Chuo
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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12
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Donohue LT, Hoffman KR, Marcin JP. Use of Telemedicine to Improve Neonatal Resuscitation. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E50. [PMID: 30939758 PMCID: PMC6518228 DOI: 10.3390/children6040050] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
Most newborn infants do well at birth; however, some require immediate attention by a team with advanced resuscitation skills. Providers at rural or community hospitals do not have as much opportunity for practice of their resuscitation skills as providers at larger centers and are, therefore, often unable to provide the high level of care needed in an emergency. Education through telemedicine can bring additional training opportunities to these rural sites in a low-resource model in order to better prepare them for advanced neonatal resuscitation. Telemedicine also offers the opportunity to immediately bring a more experienced team to newborns to provide support or even lead the resuscitation. Telemedicine can also be used to train and assist in the performance of emergent procedures occasionally required during a neonatal resuscitation including airway management, needle thoracentesis, and umbilical line placement. Telemedicine can provide unique opportunities to significantly increase the quality of neonatal resuscitation and stabilization in rural or community hospitals.
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Affiliation(s)
- Lee T Donohue
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Kristin R Hoffman
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - James P Marcin
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
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13
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Impact of Synchronous Telemedicine Models on Clinical Outcomes in Pediatric Acute Care Settings: A Systematic Review. Pediatr Crit Care Med 2018; 19:e662-e671. [PMID: 30234678 DOI: 10.1097/pcc.0000000000001733] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the impact of synchronous telemedicine models on the clinical outcomes in pediatric acute care settings. DATA SOURCES Citations from EBM Reviews, MEDLINE, EMBASE, Global Health, PubMed, and CINAHL. STUDY SELECTION We identified studies that evaluated the impact of synchronous telemedicine on clinical outcomes between January 2000 and April 2018. All studies involving acutely ill children in PICUs, pediatric cardiac ICUs, neonatal ICUs, and pediatric emergency departments were included. Publication inclusion criteria were study design, participants characteristics, technology type, interventions, settings, outcome measures, and languages. DATA EXTRACTION Two authors independently screened each article for inclusion and extracted information, including telecommunication method, intervention characteristics, sample characteristics and size, outcomes, and settings. DATA SYNTHESIS Out of the 789 studies initially identified, 24 were included. The six main outcomes of interest published were quality of care, hospital and standardized mortality rate, transfer rate, complications and illness severity, change in medical management, and length of stay. The use of synchronous telemedicine results improved quality of care and resulted in a decrease in the transfer rate (31-87.5%) (four studies), a shorter length of stay (8.2 vs 15.1 d) (six studies), a change or reinforcement of the medical care plan, a reduction in complications and illness severity, and a low hospital and standardized mortality rate. Overall, the quality of the included studies was weak. CONCLUSIONS Despite the broad recommendations found for using telemedicine in pediatric acute care settings, high-quality evidence of its impacts is still lacking. Further robust studies are needed to better determine the clinical effectiveness and the associated impacts of telemedicine in pediatric acute care settings.
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14
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Butler L, Whitfill T, Wong AH, Gawel M, Crispino L, Auerbach M. The Impact of Telemedicine on Teamwork and Workload in Pediatric Resuscitation: A Simulation-Based, Randomized Controlled Study. Telemed J E Health 2018; 25:205-212. [PMID: 29957150 DOI: 10.1089/tmj.2018.0017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Telemedicine provides access to specialty care to critically ill patients from a geographic distance. The effects of using telemedicine on (1) teamwork and communication (TC), (2) task workload during resuscitation, and (3) the processes of critical care have not been well described. OBJECTIVES To evaluate the impact of telemedicine on (1) TC, (2) task workload during a resuscitation, and (3) the processes of critical care during a simulated pediatric resuscitation. METHODS Prospective single-center randomized trial. Teams of two physicians (senior and junior resident) and two standardized confederate nurses were randomized to either telemedicine (telepresent senior physician team leader) or usual care (both physicians in the room) during a simulated infant resuscitation. Simulations were video recorded and assessed for teamwork, workload, and processes of care using the Simulated Team Assessment Tool (STAT), the NASA Task Load Index (NASA-TLX) tool, and time between onset of ventricular fibrillation and defibrillation, respectively. RESULTS Twenty teams participated. There was no difference in teamwork between the groups (mean STAT score 72% vs. 69%; p = 0.383); however, there was a significantly greater workload in the telemedicine group (mean TLX score 56% vs. 48%, p = 0.020). Using linear regression, no difference was found in time-to-defibrillation between groups (p = 0.671), but higher teamwork scores predicted faster time to defibrillation (p = 0.020). CONCLUSIONS In this simulation-based study, a telepresent team leader was associated with increased team workload compared to usual care. However, no differences were noted in teamwork and processes of care metrics.
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Affiliation(s)
- Lucas Butler
- 1 Department of Emergency Medicine, University of Washington, Seattle, Washington.,2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Travis Whitfill
- 2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Ambrose H Wong
- 3 Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcie Gawel
- 4 Department of Community Outreach, Yale-New Haven Hospital, New Haven, Connecticut
| | - Lauren Crispino
- 2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Marc Auerbach
- 2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut.,3 Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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