Simulation to implement a novel system of care for pediatric critical airway obstruction.
ABSTRACT 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.
Article: Pediatric Stridor[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; · 1.34 Impact Factor