Simulation to Implement a Novel System of Care for Pediatric Critical Airway Obstruction

Archives of otolaryngology--head & neck surgery (Impact Factor: 2.33). 10/2012; 138(10):907-11. DOI: 10.1001/2013.jamaoto.216
Source: PubMed


OBJECTIVE To implement a novel system of care for pediatric critical airway obstruction. DESIGN Retrospective, observational study of data gathered prospectively during high-fidelity simulations. SETTING Emergency department (ED) and operating rooms (ORs) of a pediatric referral center. SUBJECTS Health care provider simulation participants. MAIN OUTCOME MEASURES Time from ED attending physician request to arrival of an otolaryngologist, participant survey responses, identified latent safety threats, and simulated patient outcomes. METHODS Twelve high-fidelity simulations were conducted: 6 to identify problems with an existing system of care, and 6 to implement a novel system. The simulation scenarios involved a 4-year-old patient with severe respiratory distress after foreign-body aspiration managed solely in the ED or in the ED and OR, depending on stability. RESULTS There were 196 participants in 12 simulations. The mean (SD) time from ED attending physician request to otolaryngologist arrival was 7.8 (1.6) minutes for the existing system simulations and 5.0 (1.1) minutes for the novel system (P = .001). Latent safety threats identified in the simulations included a lack of specialized airway equipment in the ED. Death of the simulated patient occurred in the ED in 2 of 6 existing system simulations; specialized airway equipment was available for neither. For the novel system simulations, specialized airway equipment was available for all 6, no simulated patient deaths occurred. CONCLUSIONS High-fidelity simulation was an effective method to design and implement a novel system of care for pediatric critical airway obstruction. The novel system was associated with more rapid response times and elimination of simulated patient deaths.

2 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. Web-based survey. US otolaryngology residency training programs. An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
    Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P47-P47. DOI:10.1177/0194599814541627a60 · 2.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pediatric stridor is an important symptom of upper airway obstruction, and must be recognized early by evaluating physicians. Proper evaluation and management, both acutely and chronically, can provide improved outcomes and better quality of life for patients. This article discusses the physiology of stridor and its intimate relation to airway anatomy, the work-up of the stridorous child, and recent advances in treatment, and provides illustrative examples of common lesions.
    Otolaryngologic Clinics of North America 10/2014; 47(5). DOI:10.1016/j.otc.2014.06.005 · 1.49 Impact Factor