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Coulombe P, Malo C, Robitaille-Fortin M, Nadeau A, Émond M, Moore L, Blanchard PG, Benhamed A, Mercier E. Identification and Management of Pelvic Fractures in Prehospital and Emergency Department Settings. J Surg Res 2024; 300:371-380. [PMID: 38843724 DOI: 10.1016/j.jss.2024.05.006] [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: 01/19/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION This study aims to describe the characteristics of patients with a pelvic fracture treated at a level 1 trauma center, the proportion of prehospital undertriage and the use of pelvic circumferential compression device (PCCD). METHODS This is a retrospective cohort study. Prehospital and inhospital medical records of adults (≥16 y old) with a pelvic fracture who were treated at Hopital de l'Enfant-Jesus-CHU de Québec (Quebec City, Canada), a university-affiliated level 1 trauma center, between September 01, 2017 and September 01, 2021 were reviewed. Isolated hip or pubic ramus fracture were excluded. Data are presented using proportions and means with standard deviations. RESULTS A total of 228 patients were included (males: 62.3%; mean age: 54.6 [standard deviation 21.1]). Motor vehicle collision (47.4%) was the main mechanism of injury followed by high-level fall (21.5%). Approximately a third (34.2%) needed at least one blood transfusion. Compared to those admitted directly, transferred patients were more likely to be male (73.0% versus 51.3%, P < 0.001) and to have a surgical procedure performed at the trauma center (71.3% versus 46.9%, P < 0.001). The proportion of prehospital undertriage was 22.6%. Overall, 17.1% had an open-book fracture and would have potentially benefited from a prehospital PCCD. Forty-six transferred patients had a PCCD applied at the referral hospital of which 26.1% needed adjustment. CONCLUSIONS Pelvic fractures are challenging to identify in the prehospital environment and are associated with a high undertriage of 22.6%. Reducing undertriage and optimizing the use of PCCD are key opportunities to improve care of patients with a pelvic fracture.
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Affiliation(s)
- Pascale Coulombe
- VITAM - Centre de Recherche en Santé Durable de l'Université Laval, Québec, Canada
| | - Christian Malo
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de Recherche en Traumatologie - Urgences - Soins Intensifs, Centre de Recherche du CHU de Québec - Université Laval, Québec, QC, Canada; Département de Médecine Familiale et de Médecine D'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | | | - Alexandra Nadeau
- VITAM - Centre de Recherche en Santé Durable de l'Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Unité de Recherche en Traumatologie - Urgences - Soins Intensifs, Centre de Recherche du CHU de Québec - Université Laval, Québec, QC, Canada
| | - Marcel Émond
- VITAM - Centre de Recherche en Santé Durable de l'Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Unité de Recherche en Traumatologie - Urgences - Soins Intensifs, Centre de Recherche du CHU de Québec - Université Laval, Québec, QC, Canada; Département de Médecine Familiale et de Médecine D'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Lynne Moore
- Département de Médecine Préventive, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Pierre-Gilles Blanchard
- VITAM - Centre de Recherche en Santé Durable de l'Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Unité de Recherche en Traumatologie - Urgences - Soins Intensifs, Centre de Recherche du CHU de Québec - Université Laval, Québec, QC, Canada; Département de Médecine Familiale et de Médecine D'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Axel Benhamed
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de Recherche en Traumatologie - Urgences - Soins Intensifs, Centre de Recherche du CHU de Québec - Université Laval, Québec, QC, Canada; Département de Médecine Familiale et de Médecine D'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Eric Mercier
- VITAM - Centre de Recherche en Santé Durable de l'Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Unité de Recherche en Traumatologie - Urgences - Soins Intensifs, Centre de Recherche du CHU de Québec - Université Laval, Québec, QC, Canada; Département de Médecine Familiale et de Médecine D'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada.
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O'Leary F. Simulation based education in paediatric resuscitation. Paediatr Respir Rev 2024:S1526-0542(24)00046-0. [PMID: 38851950 DOI: 10.1016/j.prrv.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 06/10/2024]
Abstract
There is increasing use of clinical Simulation Based Education (SBE) in healthcare due to an increased focus on patient safety, the call for a new training model not based solely on apprenticeship, a desire for standardised educational opportunities that are available on-demand, and a need to practice and hone skills in a controlled environment. SBE programs should be evaluated against Kirkpatrick level 3 or 4 criteria to ensure they improve patient or staff outcomes in the real world. SBE programs have been shown to improve outcomes in neonatology - reductions in hypoxic ischaemic encephalopathy, in brachial plexus injury, rates of school age cerebral palsy, reductions in 24hr mortality and improvements in first pass intubation rates. In paediatrics SBE programs have shown improvements in paediatric cardiac arrest survival, PICU survival, reduced PICU admissions, reduced PICU length of stay and reduced time to critical operations. SBE can improve the non-technical tasks of teamwork, leadership and communication (within the team and with patients and carers). Simulation is a useful tool in Quality and Safety and is used to identify latent safety issues that can be addressed by future programs. In high stakes assessment simulation can be a mode of assessment, however, care needs to be taken to ensure the tool is validated carefully.
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Affiliation(s)
- Fenton O'Leary
- Department of Paediatric Emergency Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School Westmead, NSW, Australia.
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Ma J, Wang Q, Xia X, Guo Z, Feng Q, Zhou Y, Yuan H. Inclusion of the workshop model in the standardized training of emergency medicine residents. Heliyon 2023; 9:e15942. [PMID: 37305483 PMCID: PMC10256911 DOI: 10.1016/j.heliyon.2023.e15942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023] Open
Abstract
Background Standardized training of resident physicians (STRP) includes clinical practice, professional required courses, and public required courses, among others. Of them, clinical practice is the most important as it allows residents to implement what they have learned in theoretical education to practice. Clinical practice includes different teaching methods, such as traditional lectures, bedside teaching, and workshops, and each method has its advantages and disadvantages in different situations of interest. Emergency medicine (EM) focuses on the diagnosis and treatment of urgent medical conditions and entails several emergency procedures. In this study, we aimed to compare the effects of workshop-based STRP and traditional STRP on emergency physicians. Methods Overall, 125 residents who received STRP in EM between January and December 2021 were selected and randomly divided into two groups: the control group (n = 60; received traditional teaching) and the intervention group (n = 65; received workshop-based training). The theoretical performance, operative performance, and satisfaction of both groups were compared and analyzed. Results Regarding theoretical assessment, the scores of airway management, cardiopulmonary resuscitation, and trauma management in the intervention group were 4.81 (t = 5.82, p < 0.001), 6.90 (t = 7.72, p < 0.001), and 5.25 (t = 6.14, p < 0.001), respectively. Regarding skill assessment, the scores for the same items in the intervention group were 4.43 (t = 5.30, p < 0.001), 4.55 (t = 5.61, p < 0.001), and 5.62 (t = 6.65, P < 0.001), respectively. Regarding satisfaction evaluation, the scores in the intervention group were 1.99 (t = 6.03, p < 0.001), 1.98 (t = 6.41, p < 0.001), and 1.96 (t = 6.14, p < 0.001), respectively. Overall, the scores were higher in the intervention group than in the control group. Conclusion The workshop training model effectively improves the theoretical knowledge and practical skills of EM residents undergoing standardized training. The residents found the training and its outcomes satisfactory, ultimately improving their emergency response and first-responder skills.
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Affiliation(s)
| | | | | | | | | | | | - Hua Yuan
- Corresponding author. Department of Emergency Medicine, Affiliated Kunshan Hospital of Jiangsu University, No. 91 Qianjin West Road, Kunshan, 215300, China.
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Brogaard L, Hvidman L, Esberg G, Finer N, Hjorth-Hansen KR, Manser T, Kierkegaard O, Uldbjerg N, Henriksen TB. Teamwork and Adherence to Guideline on Newborn Resuscitation-Video Review of Neonatal Interdisciplinary Teams. Front Pediatr 2022; 10:828297. [PMID: 35265565 PMCID: PMC8900704 DOI: 10.3389/fped.2022.828297] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Little is known about the importance of non-technical skills for the adherence to guidelines, when teams of midwives, obstetricians, anesthesiologists, and pediatricians resuscitate and support the transition of newborns. Non-technical skills are competences underpinning successful teamwork in healthcare. These are usually referred to as leadership, situational awareness, communication, teamwork, decision making, and coping with stress and fatigue. OBJECTIVE By review of videos of teams managing newborns with difficult transition, we aimed to investigate whether the level of the teams' non-technical skills was associated with the degree of adherence to guidelines for newborn resuscitation and transitional support at birth. METHODS Four expert raters independently assessed 43 real-life videos of teams managing newborns with transitional difficulties, two assessed the non-technical score and two assessed the clinical performance. Exposure was the non-technical score, obtained by the Global Assessment Of Team Performance checklist (GAOTP). GAOTP was rated on a Likert Scale 1-5 (1 = poor, 3 = average and 5 = excellent). The outcome was the clinical performance score of the team assessed according to adherence of the European Resuscitation Counsel (ERC) guideline for neonatal resuscitation and transitional support. The ERC guideline was adapted into the checklist TeamOBS-Newborn to facilitate a structured and simple performance assessment (low score 0-60, average 60-84, high 85-100). Interrater agreement was analyzed by intraclass correlation (ICC), Bland-Altman analysis, and Cohen's kappa weighted. The risk of high and low clinical performance was analyzed on the logit scale to meet the assumptions of normality and constant standard deviation. RESULTS Teams with an excellent non-technical score had a relative risk 5.5 [95% confidence interval (CI) 2.4-22.5] of high clinical performance score compared to teams with average non-technical score. In addition, we found a dose response like association. The specific non-technical skills associated with the highest degree of adherence to guidelines were leadership and teamwork, coping with stress and fatigue, and communication with parents. Inter-rater agreement was high; raters assessing non-technical skills had an interclass coefficient (ICC) 0.88 (95% CI 0.79-0.94); the neonatologists assessing clinical performance had an ICC of 0.81 (95% CI 0.66-0.89). CONCLUSION Teams with an excellent non-technical score had five times the chance of high clinical performance compared to teams with average non-technical skills. High performance teams were characterized by good leadership and teamwork, coping with stress, and fatigue and communication with parents.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Esberg
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Neil Finer
- Department of Neonatology, University of California, San Diego, San Diego, CA, United States
| | | | - Tanja Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Ole Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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Yan DH, Slidell MB, McQueen A. Rapid Cycle Deliberate Practice Simulation Curriculum Improves Pediatric Trauma Performance: A Prospective Cohort Study. Simul Healthc 2021; 16:e94-e99. [PMID: 33156257 DOI: 10.1097/sih.0000000000000524] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulation-based medical education allows learners to refine and maintain clinical skills especially for high-stake situations such as trauma resuscitation. Despite the primary and secondary survey being its foundation, literature shows poor adherence with overall rates as low as 13%. This study evaluates the impact of rapid cycle deliberate practice (RCDP) on primary and secondary survey skill retention. We hypothesized that RCDP-trained surgery residents will have real-world clinical improvement in their survey completion in pediatric trauma resuscitations. METHODS We developed an RCDP trauma resuscitation curriculum. Videos of trauma resuscitations before and after curriculum implementation were scored by 2 blinded reviewers using a modified Pediatric Trauma Assessment Scoring Tool. Actual trauma care by residents who had received the curriculum (study group) was compared with care provided by residents who had not received the curriculum (precurriculum historical control group and a concurrent control group who provided care without receiving the curriculum). RESULTS One hundred eighty-eight videos were scored with 98 in study group, 33 in concurrent control group, and 57 in historical control group. There was a significant improvement in primary survey performance between study group and historical control group (P < 0.001), but no difference between study group and concurrent control group. There was a significant improvement between study group and 2 control groups in secondary survey performance (both P < 0.001). CONCLUSIONS The RCDP curriculum led to significant improvement in surgical residents' trauma survey performance and had clinical impact on actual patients, which is rare in pediatric trauma simulation literature.
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Affiliation(s)
- Diana Hou Yan
- From the Department of Pediatrics, Section of Emergency Medicine (D.H.Y., A.M.), University of Chicago Medicine, Comer Children's Hospital; and Department of Surgery, Section of Pediatric Surgery (M.B.S.), University of Chicago Medicine, Chicago, IL
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Linders M, Binkhorst M, Draaisma JMT, van Heijst AFJ, Hogeveen M. Adherence to the ABCDE approach in relation to the method of instruction: a randomized controlled simulation study. BMC Emerg Med 2021; 21:121. [PMID: 34654364 PMCID: PMC8517297 DOI: 10.1186/s12873-021-00509-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is widely recommended and taught in many resuscitation courses. This study assessed the adherence to the ABCDE algorithm and whether this was affected by the instruction method used to teach this approach. Methods Randomized controlled trial in which simulation was used as investigational method. Between June 2017 and January 2018, neonatal healthcare providers routinely participated in simulated neonatal advanced life support (NALS) scenarios, using a high-fidelity manikin. They were randomly assigned to a video-based instruction (intervention group) or a conventional lecture (control group) as the method of instruction. One blinded researcher evaluated the adherence to the ABCDE approach on video with an assessment tool specifically designed and tested for this study. The primary outcomes were: 1) the overall adherence and 2) the between-group difference in individual adherence to the ABCDE approach, both expressed as a percentage score. Secondary outcomes were: 1) the scores of each profession category (nurses, neonatal ward clinicians, fellows/neonatologists) and 2) the scores for the separate domains (A, B, C, D, and E) of the algorithm. Results Seventy-two participants were assessed. Overall mean (SD) percentage score (i.e. overall adherence) was 31.5% (19.0). The video-based instruction group (28 participants) adhered better to the ABCDE approach than the lecture group (44 participants), with mean (SD) scores of 38.8% (18.7) and 27.8% (18.2), respectively (p = 0.026). The difference in adherence between both groups could mainly be attributed to differences in the adherence to domain B (p = 0.023) and C (p = 0.007). Neonatal ward clinicians (39.9% (18.2)) showed better adherence than nurses (25.0% (15.2)), independent of the study group (p = 0.010). Conclusions Overall adherence to the ABCDE algorithm was rather low. Video-based instruction resulted in better adherence to the ABCDE approach during NALS training than lecturing. Trial registration ISRCTN registry, trial ID ISRCTN95998973, retrospectively registered on October 13th, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00509-0.
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Affiliation(s)
- Marjolein Linders
- Radboud Institute for Health Sciences, Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Mathijs Binkhorst
- Department of Neonatology, Radboud University Medical Center Amalia Children's Hospital, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Jos M T Draaisma
- Radboud Institute for Health Sciences, Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Arno F J van Heijst
- Department of Neonatology, Radboud University Medical Center Amalia Children's Hospital, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Radboud University Medical Center Amalia Children's Hospital, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
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Kelley MN, Mercurio L, Tsao HS, Toomey V, Carillo M, Brown L, Wing R. Excellence in Communication and Emergency Leadership (ExCEL): Pediatric Primary and Secondary Survey in Trauma Workshop for Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11079. [PMID: 33501375 PMCID: PMC7821439 DOI: 10.15766/mep_2374-8265.11079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/06/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Unintentional traumatic injury remains the leading cause of pediatric death in the United States. There is wide variation in the assessment and management of pediatric trauma patients in emergency departments. Resident education on trauma evaluation and management is lacking. This workshop focused on developing resident familiarity with the primary and secondary trauma survey in pediatric patients. METHODS This hands-on workshop utilized patient-actors and low-fidelity simulators to instruct learners on the initial assessment of trauma patients during the primary and secondary trauma surveys. It was designed for residents across all levels of training who care for pediatric trauma patients (including pediatrics, medicine-pediatrics, emergency medicine, and family medicine) and adapted for different session durations and learner group sizes. RESULTS Eighteen residents participated in this workshop at two separate institutions. Participants strongly agreed that the workshop was relevant and effective in teaching the initial primary and secondary trauma survey assessment of pediatric trauma patients. Residents also reported high levels of confidence in performing a primary and secondary trauma survey after participation in the workshop. DISCUSSION This workshop provided residents with instruction and practice in performing the primary and secondary trauma survey for injured pediatric patients. Additional instruction is needed on assigning Glasgow Coma Scale and AVPU (alert, voice, pain, unresponsive) scores to injured patients. The structure and time line of this curriculum can be adapted to the needs of an individual institution's program and the number of workshop participants.
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Affiliation(s)
- Mariann Nocera Kelley
- Assistant Professor, Departments of Pediatrics and Emergency Medicine/Traumatology, Division of Pediatric Emergency Medicine, University of Connecticut School of Medicine and Connecticut Children's; Director of Simulation Education, University of Connecticut School of Medicine
| | - Laura Mercurio
- Fellow, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital
| | - Hoi See Tsao
- Fellow, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital
| | - Vanessa Toomey
- Clinical Fellow, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School and Boston Children's Hospital
| | - Marie Carillo
- Fellow, Department of Cardiology, Children's National Hospital
| | - Linda Brown
- Associate Professor, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Vice Chair of Pediatric Emergency Medicine, Hasbro Children's Hospital; Director, Lifespan Medical Simulation Center
| | - Robyn Wing
- Assistant Professor, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Director of Pediatric Simulation, Lifespan Medical Simulation Center
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Hulfish E, Diaz MCG, Feick M, Messina C, Stryjewski G. The Impact of a Displayed Checklist on Simulated Pediatric Trauma Resuscitations. Pediatr Emerg Care 2021; 37:23-28. [PMID: 29489608 DOI: 10.1097/pec.0000000000001439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Advanced Trauma Life Support resuscitation follows a strict protocolized approach to the initial trauma evaluation. Despite this structure, elements of the primary and secondary assessments can still be omitted. The aim of this study is to determine if a cognitive aid checklist reduces omissions and speeds the time to assessment completion. We additionally investigated if a displayed checklist improved performance further. METHODS A series of 131 simulated trauma resuscitations were performed. Teams were randomized to 1 of 3 arms (no checklist, handheld checklist, or displayed). The scenarios were recorded and analyzed to determine time to completion and absolute completion of tasks of the primary and secondary survey. The workload of individual team members was assessed via NASA-TLX. RESULTS There was no difference in time to completion of surveys among the 3 arms. In the primary survey, there was a nonsignificant increase in the number of completed tasks with the use of the displayed checklist. In the secondary survey, there was a significant improvement in task completion with the displayed checklists with improved evaluation of the pelvis (P = 0.011), lower extremities (P = 0.048), and covering the patient (P = 0.046). There was a significant improvement in performance in those reported among nurse documenters with use of the displayed checklist. CONCLUSIONS Despite a structured approach to trauma resuscitations, omissions still occur. The use of a displayed checklist improves performance and reduces omissions without delaying assessment. Better compliance with Advanced Trauma Life Support protocols may improve patient outcomes.
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Affiliation(s)
- Erin Hulfish
- From the Stony Brook Children's Hospital, Stony Brook University, Stony Brook, NY
| | - Maria Carmen G Diaz
- Nemours/AI duPont Hospital for Children, Thomas Jefferson University, Wilmington, DE
| | - Megan Feick
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Catherine Messina
- Deparment of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Glenn Stryjewski
- Inpatient Medical Director, Pediatric Intensive Care Unit, Alaska Native Medical Center, Anchorage, AK
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How Much Cardiopulmonary Resuscitation Does a Pediatric Emergency Provider Perform in 1 Year? A Video-Based Analysis. Pediatr Emerg Care 2020; 36:327-331. [PMID: 30247459 DOI: 10.1097/pec.0000000000001625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We aimed to quantify time performing chest compressions (CCs) per year of individual providers in a pediatric ED and to project a rate of opportunity for CC based on median clinical hours per provider category. METHODS This was an observational study of video-recorded resuscitations in a pediatric ED over 1 year. Events where CCs were performed for more than 2 minutes were included. Identification of providers and duration of CCs per provider were determined by video review. Time of CCs was totaled per provider over the study period. Data were expressed as median and interquartile range (IQR). Rate of opportunity for providing CC to a child was calculated by dividing the median clinical hours per year per provider type by the number of CC events per year. RESULTS Twenty-three CC events totaling 340 minutes of CCs were analyzed. Chest compressions were performed by 6 (13%) of 45 attending physicians, 3 (25%) of 12 fellows, 32 (22%) of 143 nurses, and 19 (59%) of 32 technicians. The median amount of time performing CC was 182 seconds (IQR, 91-396 seconds); by provider category, median amount of time was as follows: attending physicians, 83 seconds (IQR, 64-103 seconds); fellows, 45 seconds (IQR, 6-83 seconds); nurses, 128 seconds (IQR, 93-271 seconds); and technicians, 534 seconds (IQR, 217-793 seconds). The projected hours needed for an opportunity to perform CCs was 730 hours (91 shifts) for attending physicians, 243 hours (30 shifts) for fellows, and 1460 hours (121 shifts) for nurses and technicians. CONCLUSIONS Performing CCs on children in the ED is a rare event, with a median of 3 minutes per provider per year. Future studies should determine training methods to optimize readiness for these rare occurrences.
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Jabaay MJ, Grcevich LO, Marotta DA, Reynolds JH. Trauma and Triage: Applying the Dick and Carey Instructional Design Model to a Primary Survey Clinical Workshop. Cureus 2020; 12:e8656. [PMID: 32685321 PMCID: PMC7366068 DOI: 10.7759/cureus.8656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Instructional design in the setting of medical education can be challenging. Multiple instructional design methods exist and have been documented in the literature. However, detailed applications of these models in the context of medical education are underreported. This technical report describes the application of a specific instructional design model to an acute care curriculum. Specifically, we illustrate the Dick and Carey instructional design model used at a one-day clinical workshop aimed at improving medical student exposure to the primary survey.
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Affiliation(s)
- Maxwell J Jabaay
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Leah O Grcevich
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Dario A Marotta
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA.,Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, USA
| | - Joseph H Reynolds
- Department of Leadership and Professional Studies, Troy University, Montgomery, USA
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Analysis of CPR quality by individual providers in the pediatric emergency department. Resuscitation 2020; 153:37-44. [PMID: 32505613 DOI: 10.1016/j.resuscitation.2020.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/23/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To describe chest compression (CC) quality by individual providers in two pediatric emergency departments (EDs) using video review and compression monitor output during pediatric cardiac arrests. METHODS Prospective observational study. Patients <18 yo receiving CC for >1 min were eligible. Data was collected from video review and CC monitor device in a synchronized fashion and reported in 'segments' by individual providers. Univariate comparison by age (<1 yo, 1-8 yo, >8 yo) was performed by chi-square testing for dichotomous variables ('high-quality' CPR) and nonparametric testing for continuous variables (CC rate and depth). Univariate comparison of ventilation rate (V) was made between segments with an advanced airway versus without. RESULTS 524 segments had data available; 42/524 (8%) met criteria for 'high-quality CC'. Patients >8 yo had more segments meeting criteria (18% vs. 2% and 0.5%; p < 0.001). Segments compliant for rate were less frequent in <1 yo (17% vs. 24% vs. 27%; p = 0.03). Segments compliant for depth were less frequent in <1 year olds and 1-8 year olds (5% and 9% vs. 20%, p < 0.001.) Mean V for segments with an advanced airway was higher than with a natural airway (24 ± 18 vs. 14 ± 10 bpm, p < 0.001). Hyperventilation was more prevalent in CPR segments with an advanced airway (66% vs. 32%, p < 0.001). CONCLUSIONS CC depth is rarely guideline compliant in infants. Hyperventilation is more prevalent during CPR periods with an advanced airway in place. Measuring individual provider CPR quality is feasible, allowing future studies to evaluate the impact of CPR training.
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Yan DH, Slidell MB, McQueen A. Using rapid cycle deliberate practice to improve primary and secondary survey in pediatric trauma. BMC MEDICAL EDUCATION 2020; 20:131. [PMID: 32345288 PMCID: PMC7189590 DOI: 10.1186/s12909-020-02038-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Optimal performance of the primary and secondary survey is the foundation of Advance Trauma Life Support care. Despite its importance, not all primary surveys completed at level 1 pediatric trauma centers are performed according to established guidelines (Gala et al., Pediatr Emerg Care 32:756-762, 2016, Carter et al., Resuscitation 84:66-71, 2013). We hypothesize that rapid cycle deliberate practice (RCDP) will improve surgical residents' confidence in performing the primary and secondary survey. METHODS We developed a curriculum to teach surgical interns the principles of performing the primary and secondary survey using RCDP. Surveys distributed after each session assessed the impact of the curriculum on learner confidence and perception that this curriculum would benefit patient care. Questions were scored on a 5-point Likert scale. Sixteen surgical interns participated during intern orientation and 100% of the participants completed the post curriculum survey. RESULTS Thirteen (81%) of participants agreed or strongly agreed that the simulation would impact future performance in the pediatric trauma bay. The curriculum also significantly improved the confidence of our learners to perform trauma surveys (p < 0.001). CONCLUSION This curriculum improves the confidence of junior surgical residents in learning the primary and secondary survey. Most learners enjoyed the session and felt that the curriculum would positively impact their performance.
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Affiliation(s)
- Diana Hou Yan
- Department of Pediatrics, Section of Emergency Medicine, University of Chicago Medicine, 5841 S Maryland Ave, Mailcode 0810, Chicago, IL 60637 USA
| | - Mark B Slidell
- Department of Surgery, University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL USA
| | - Alisa McQueen
- Department of Pediatrics, Section of Emergency Medicine, University of Chicago Medicine, 5841 S Maryland Ave, Mailcode 0810, Chicago, IL 60637 USA
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Brogaard L, Uldbjerg N. Filming for auditing of real-life emergency teams: a systematic review. BMJ Open Qual 2019; 8:e000588. [PMID: 31909207 PMCID: PMC6937091 DOI: 10.1136/bmjoq-2018-000588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 08/02/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynaecology, Regionshospitalet Horsens, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Mitra B, Bade-Boon J, Fitzgerald MC, Beck B, Cameron PA. Timely completion of multiple life-saving interventions for traumatic haemorrhagic shock: a retrospective cohort study. BURNS & TRAUMA 2019; 7:22. [PMID: 31360731 PMCID: PMC6637602 DOI: 10.1186/s41038-019-0160-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/07/2019] [Indexed: 11/10/2022]
Abstract
Background Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury. Improved outcomes have been previously associated with single, timely interventions. The aim of this study was to assess the association between multiple timely life-saving interventions (LSIs) and outcomes of traumatic haemorrhagic shock patients. Methods A retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency & Trauma Centre between July 01, 2010 and July 31, 2014. LSIs studied included chest decompression, control of external haemorrhage, pelvic binder application, transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative intervention. The primary exposure variable was timely initiation of ≥ 50% of the indicated interventions. The association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression analysis. The association between total pre-hospital times and pre-hospital care times (time from ambulance at scene to trauma centre), in-hospital mortality and timely initiation of ≥ 50% of the indicated interventions were assessed. Results Of the 168 patients, 54 (32.1%) patients had ≥ 50% of indicated LSI completed within the specified time period. Timely delivery of LSI was independently associated with improved survival to hospital discharge (adjusted odds ratio (OR) for in-hospital death 0.17; 95% confidence interval (CI) 0.03–0.83; p = 0.028). This association was independent of patient age, pre-hospital care time, injury severity score, initial serum lactate levels and coagulopathy. Among patients with pre-hospital time of ≥ 2 h, 2 (3.6%) received timely LSIs. Pre-hospital care times of ≥ 2 h were associated with delayed LSIs and with in-hospital death (unadjusted OR 4.3; 95% CI 1.4–13.0). Conclusions Timely completion of LSI when indicated was completed in a small proportion of patients and reflects previous research demonstrating delayed processes and errors even in advanced trauma systems. Timely delivery of a high proportion of LSIs was associated with improved outcomes among patients presenting with haemorrhagic shock after injury. Provision of LSIs in the pre-hospital phase of trauma care has the potential to improve outcomes.
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Affiliation(s)
- Biswadev Mitra
- 1National Trauma Research Institute, The Alfred Hospital, 89 Commercial Road, Melbourne, VIC 3004 Australia.,2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.,3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,5Faculty of Medicine, Laval University, Quebec City, Quebec Canada
| | - Jordan Bade-Boon
- 1National Trauma Research Institute, The Alfred Hospital, 89 Commercial Road, Melbourne, VIC 3004 Australia.,2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Mark C Fitzgerald
- 4Trauma Service, The Alfred Hospital, Melbourne, Australia.,5Faculty of Medicine, Laval University, Quebec City, Quebec Canada
| | - Ben Beck
- 3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,5Faculty of Medicine, Laval University, Quebec City, Quebec Canada
| | - Peter A Cameron
- 1National Trauma Research Institute, The Alfred Hospital, 89 Commercial Road, Melbourne, VIC 3004 Australia.,2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.,3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Videographic Assessment of Pediatric Tracheal Intubation Technique During Emergency Airway Management. Pediatr Crit Care Med 2018; 19:e136-e144. [PMID: 29504951 DOI: 10.1097/pcc.0000000000001423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine technical aspects of pediatric tracheal intubation using video recording and to determine the association between tracheal intubation technique and procedural outcomes. DESIGN Prospective observational study. SETTING Emergency department resuscitation bay in single tertiary pediatric center. PATIENTS Children undergoing emergent tracheal intubation under videorecorded conditions. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A published scoring tool for characterizing patient positioning, intubator kinematics, and adjunctive maneuvers during tracheal intubation was applied to videorecorded pediatric resuscitations when tracheal intubation was performed. Procedural outcomes were measured from video review. Seventy-one children underwent 109 tracheal intubation attempts with an overall first attempt success rate of 69% and a median laryngoscopy duration of 34 seconds (interquartile range, 24-47 s). A significant subset of tracheal intubation attempts were made with the patient's bed at a height below the level of intubator's umbilicus (61%), the patient in a supine position without head elevation (55%), the intubator bent at the waist to greater than 45° (66%), less than 1 cm of mouth opening by the intubator's right hand prior to laryngoscopy (46%), and with the intubator's face less than 12 inches away from the patient's mouth (65%). Adjunctive maneuvers were used in a minority of attempts (cricoid pressure 48%, external laryngeal manipulation 11%, retraction of the right corner of the patient's mouth 26%). On multivariate analysis, including controlling for patient age category and intubator background, retraction of the right corner of the patient's mouth by an assistant showed an independent association with successful tracheal intubation. No other technical aspects were associated with tracheal intubation success. CONCLUSIONS Intubators commonly exhibited suboptimal technique during tracheal intubation such as bending deeply at the waist, having their eyes close to the patient's mouth, failing to widely open the patient's mouth, and not elevating the occiput in older children. Retraction of the right corner of the patient's mouth by an assistant during laryngoscopy and intubation was associated with TI success.
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