David O Kessler

David O Kessler
  • MD, MSc
  • Vice Chair at Columbia University

About

173
Publications
45,848
Reads
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4,915
Citations
Introduction
Dr. Kessler is Associate Professor & Vice Chair of Innovation & Strategic Initiatives for the Dept of Emergency Medicine at Columbia University Irving Medical Center. He is an associate medical director for the Jaharis Simulation simulation center with focus on in situ simulation, system integration and quality improvement. He is prior director & one of the founders of INSPIRE (http://inspiresim.com/). Research interests include patient oriented outcomes, quality improvement, & skills training.
Current institution
Columbia University
Current position
  • Vice Chair

Publications

Publications (173)
Article
Objectives Acute appendicitis is a common surgical emergency in children. Prior radiology studies have described Puylaert staging on ultrasound to determine the severity of appendicitis. We investigated the feasibility and utility of assessing Puylaert staging on emergency department (ED) point‐of‐care ultrasound (POCUS) to differentiate uncomplica...
Article
Objectives This study aims to establish and evaluate validity data for pediatric difficult intravenous access (DIVA) scores in low-resource emergency care settings within low- to middle-income countries (LMIC). We also sought to explore associated factors for DIVA that could contribute to a modified pediatric DIVA score with optimal performance in...
Preprint
Full-text available
Developing reliable healthcare AI models requires training with representative and diverse data. In imbalanced datasets, model performance tends to plateau on the more prevalent classes while remaining low on less common cases. To overcome this limitation, we propose DiffUltra, the first generative AI technique capable of synthesizing realistic Lun...
Article
Objective The aim of the study is to determine if there is a correlation between perceived staff workload, measured by the NASA Task Load Index (TLX), and the National Emergency Department Overcrowding Scale (NEDOCS) in a pediatric ED. Methods We collected staff questionnaires in a large, urban pediatric ED to assess perceived workload on each of...
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Background and objectives Severe pneumonia is the leading cause of death among young children worldwide, disproportionately impacting children who lack access to advanced diagnostic imaging. Here our objectives were to develop and test the accuracy of an artificial intelligence algorithm for detecting features of pulmonary consolidation on point-of...
Article
Introduction With increased incorporation of simulation-based methodologies into quality improvement activities, standards for reporting on simulation-specific elements in healthcare improvement research are needed. Methods We followed established consensus process methodology to iteratively create simulation-based extensions for SQUIRE 2.0 report...
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Children with heart disease are at increased risk of unstable dysrhythmias and in-hospital cardiac arrest (IHCA). Clinician adherence to lifesaving processes of care is an important contributor to improving patient outcomes. This study evaluated whether critical event checklists improve adherence to lifesaving processes during simulated acute event...
Article
Objectives Asthma is a leading cause of pediatric emergency department visits, yet few tools exist to objectively measure asthma severity. Diaphragmatic ultrasound (DUS) is a novel method of assessing respiratory distress; however, data are lacking for children. Our primary aim was to determine if diaphragmatic excursion (DE), diaphragmatic thicken...
Article
Statement Behavioral skills, sometimes referred to as nontechnical skills or team-based skills, are fundamental to simulation-based team training. These skills should be afforded the same deliberate practice and development as clinical knowledge and procedural skills in health care education. Applied improvisation, the use of theater games designed...
Article
Statement Simulation-based health professions educators can advance diversity, equity, and inclusion by cultivating structural competency, which is the trained ability to discern inequity not only at an individual level, but also at organizational, community, and societal levels. This commentary introduces Metzl and Hansen's Five-Step Model for str...
Article
Objective To determine if caregivers would be able to successfully perform in home lung ultrasounds on their children without direct supervision after undergoing a basic tutorial that would allow for expert interpretation. Methods A prospective exploratory single‐center cohort study was conducted on patients (0–18 years) presenting to a pediatric...
Article
Background Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. Methods Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommend...
Preprint
Full-text available
Frame-by-frame annotation of bounding boxes by clinical experts is often required to train fully supervised object detection models on medical video data. We propose a method for improving object detection in medical videos through weak supervision from video-level labels. More concretely, we aggregate individual detection predictions into video-le...
Article
Objectives: To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality. Methods: Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by in...
Chapter
Frame-by-frame annotation of bounding boxes by clinical experts is often required to train fully supervised object detection models on medical video data. We propose a method for improving object detection in medical videos through weak supervision from video-level labels. More concretely, we aggregate individual detection predictions into video-le...
Article
Objective: B-lines are a ring-down artifact of lung ultrasound that arise with increased alveolar water in conditions such as pulmonary edema and infectious pneumonitis. Confluent B-line presence may signify a different level of pathology compared with single B-lines. Existing algorithms aimed at B-line counting do not distinguish between single a...
Article
Sickle cell disease is the most prevalent inherited blood disorder in the world, with significant morbidity and mortality. Patients often have recurrent painful vaso‐occlusive episodes, and the American Society of Hematology gives a conditional recommendation for the use of regional anesthesia for acute sickle cell pain management. This scoping rev...
Article
Objectives: We aimed to develop a standardized scoring tool to measure point-of-care ultrasound (POCUS) image quality and to determine validity evidence for its use to assess lung ultrasound image quality. Methods: The POCUS Image Quality (POCUS IQ) scale was developed by POCUS-trained physicians to assess sonographers' image acquisition skills...
Preprint
Sickle cell disease is the most prevalent inherited blood disorder in the world, with significant morbidity and mortality. Patients often have recurrent painful vaso-occlusive episodes, and the American Society of Hematology gives a conditional recommendation for the use of regional anesthesia for acute sickle cell pain management. This scoping rev...
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Full-text available
Objective: Our objectives were to assess the comfort level of pediatric emergency physicians (PEPs) providing urgent care to adult patients on telemedicine (APOTM) when redeployed during the coronavirus disease 2019 (COVID-19) pandemic, how it changed over time, and what resources were helpful. Materials and methods: We conducted a retrospective p...
Article
Objectives: Lung ultrasound (LUS) may help determine illness severity in children with acute lower respiratory tract infections (LRTI) but limited pediatric studies exist. Our objective was to determine the association between LUS findings and illness severity in children with LRTI. Methods: We conducted a prospective study of patients <20 years...
Article
Introduction: Resuscitation events in pediatric critical and emergency care are high risk, and strong leadership is an important component of an effective response. The Concise Assessment of Leadership Management (CALM) tool, designed to assess the strength of leadership skills during pediatric crises, has shown promising validity and reliability...
Article
Background: The COVID-19 pandemic forced rapid implementation and refinement of distance simulation methodologies in which participants and/or facilitators are not physically colocated. A review of the distance simulation literature showed that heterogeneity in many areas (including nomenclature, methodology, and outcomes) limited the ability to i...
Article
Background: As simulation matures, it is critical to develop pathways for researchers. A recent analysis, however, demonstrates a low conversion rate between abstract and peer-reviewed journal publication in our field. The International Network for Simulation-based Pediatric Innovation, Research, and Education has used the ALERT Presentation proce...
Article
Objective Interfacility transport of critically ill infants and children is an essential part of the care of children in the United States. However, there is tremendous variation in how transports are coordinated and performed. Pediatric critical care medicine (PCCM) fellows have differing experiences in their fellowships, and there is no standardi...
Article
Aims Coaches improve CPR outcomes in real-world and simulated settings. To explore verbal feedback that targets CPR quality, we used Natural language processing (NLP) methodologies on transcripts from a published pediatric randomized trial (coach vs. no coach in simulated CPR). Study objectives included: determining any differences by trial arm in...
Article
Summary statement: A decade ago, at the time of formation of the International Network for Pediatric Simulation-based Innovation, Research, and Education, the group embarked on a consensus building exercise. The goal was to forecast the facilitators and barriers to growth and maturity of science in the field of pediatric simulation-based research....
Article
Background Unsafe conditions (UCs) are circumstances that increase the probability of a patient safety event occurring. Each UC identified presents an opportunity to prevent a near miss or adverse patient event through proactive mitigation. Our aim was to describe the frequency, characteristics, contributing factors, and potential for harm of repor...
Article
Summary statement: Simulation-based education is a particularly germane strategy for addressing the difficult topic of racism and implicit bias due to its immersive nature and the paradigm of structured debriefing. Researchers have proposed actionable frameworks for implicit bias education, particularly outlining the need to shift from recognition...
Chapter
This chapter addresses key questions that can guide potential collaborations with individual simulation experts or groups of experts who work in simulation centers. The science of simulation provides invaluable tools that can be used to support education, safety and quality improvement efforts, and research, making partnerships ideal in many ways....
Chapter
Developed by the leading experts in neonatal simulation, this innovative new resource delivers neonatology health care providers and educators essential guidance on designing, developing, and implementing simulation-based neonatal education programs. Available for purchase at https://shop.aap.org/neonatal-simulation-a-practical-guide-paperback/ (NO...
Article
Objectives: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 is a novel pediatric condition with significant morbidity and mortality. The primary objective of this investigation was to describe the point-of-care ultrasound (POCUS) findings in patients evaluated in the emergency department (ED) who were...
Article
Objectives: Effective cardiopulmonary resuscitation (CPR) is critical to ensure optimal outcomes from cardiac arrest, yet trained health care providers consistently struggle to provide guideline-compliant CPR. Rescuer fatigue can impact chest compression (CC) quality during a cardiac arrest event, although it is unknown if visual feedback or just-...
Article
Background: Our objective is to describe our pediatric virtual urgent care (VUC) experience at a large urban academic medical center, in response to the COVID-19 pandemic in New York City (NYC). Materials and Methods: We conducted a retrospective cohort study of our pediatric VUC program of patients less than age 18 years, from March 1 to May 31,...
Article
Objectives: To determine the impact of a cardiopulmonary resuscitation coach on the frequency and duration of pauses during simulated pediatric cardiac arrest. Design: This is a secondary analysis of video data collected from a prospective multicenter trial. Forty simulated pediatric cardiac arrest scenarios (20 noncoach and 20 coach teams), eac...
Article
Objective To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs). Study design A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readines...
Article
Lung point-of-care ultrasound (POCUS) has been shown to be useful for identifying pulmonary pathology in adult patients with coronavirus disease 2019 (COVID-19). However, pediatric literature for POCUS in COVID-19 is limited. The objective of this case series was to describe lung POCUS findings in pediatric patients with COVID-19. Three patients wi...
Article
Study Objectives: Prior to COVID-19, telemedicine and its applications to the emergency department (ED) had made significant inroads toward remote evaluation and care. During the local peak of the COVID-19 pandemic in New York City (NYC), there was a dramatic increase in telemedicine based patient encounters for suspected COVID-19 symptoms. In resp...
Article
Statement: The International Network for Simulation-based Pediatric Innovation, Research, and Education co-hosted a novel research accelerator meeting with the International Pediatric Simulation Society in May of 2019 in Toronto. The purpose of the meeting was to bring together healthcare simulation scientists with resuscitation stakeholders to br...
Article
Effective trainee‐led debriefing after critical events in the Pediatric Emergency Department has potential to improve patient care, but debriefing assessments for this context have not been developed. This study gathers preliminary validity and reliability evidence for the Debriefing Assessment for Simulation in Healthcare (DASH) as an assessment o...
Article
Full-text available
Introduction: Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric va...
Article
Objectives: Optimal cardiopulmonary resuscitation can improve pediatric outcomes but rarely is cardiopulmonary resuscitation performed perfectly despite numerous iterations of Basic and Pediatric Advanced Life Support. Cardiac arrests resuscitation events are complex, often chaotic environments with significant mental and physical workload for tea...
Article
Background: Stress may impair the success of procedures in emergency medicine. The aims were to assess residents' stress during simulated and clinical lumbar punctures (LPs) and to explore the correlation of stress and performance. Methods: A prospective study (2013-2016) was carried out in a pediatric emergency department. A mastery training an...
Chapter
On commencing any research project, a vital step is to conduct a thorough review of the literature. Over the last decade, healthcare simulation has matured as a distinct research field. However, the conceptual underpinnings for many areas of research within the field can be found in journals of other disciplines. This underscores the importance of...
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Full-text available
Background: Multi-institutional, international practice variation of pediatric anaphylaxis management by healthcare providers has not been reported. Objective: Characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. Methods: A prospective, observa...
Article
Diagnostic point-of-care ultrasound (POCUS) is a growing field across all disciplines of pediatric practice. Machine accessibility and portability will only continue to grow, thus increasing exposure to this technology for both providers and patients. Individuals seeking training in POCUS should first identify their scope of practice to determine a...
Article
Over the last two decades, the use of point‐of‐care ultrasound (POCUS) has increased exponentially in the emergency care setting1‐4. Training programs have recognized the importance of ultrasound (US) in the care of both adult and pediatric patients5‐11. The Accreditation Council for Graduate Medical Education (ACGME) has designated POCUS as a core...
Article
Objectives: We aimed to describe the impact of a cardiopulmonary resuscitation coach on healthcare provider perception of cardiopulmonary resuscitation quality during simulated pediatric cardiac arrest. Design: Prospective, observational study. Setting: We conducted secondary analysis of data collected from a multicenter, randomized trial of p...
Article
Background: Little is known about how best to motivate healthcare professionals to engage in frequent cardiopulmonary resuscitation (CPR) refresher skills practice. A competitive leaderboard for simulated CPR can encourage self-directed practice on a small scale. The study aimed to determine if a large-scale, multi-center leaderboard improved simu...
Article
Background Pediatric Emergency Medicine (PEM) Physicians have variably incorporated Point‐of‐Care Ultrasound (POCUS) into their practice. Prior guidelines describe the scope of POCUS practice for PEM physicians, however, consensus does not yet exist about which applications should be prioritized and taught as fundamental skills for PEM trainees. Me...
Article
As point-of-care ultrasound (POCUS) becomes standard practice in pediatric emergency medicine (PEM), it is important to have benchmarks in place for credentialing PEM faculty in POCUS. Faculty must be systematically trained and assessed for competency in order to be credentialed in POCUS and granted privileges by an individual institution. Recommen...
Article
Background: Capnography and cardiopulmonary resuscitation (CPR) feedback devices have been shown to improve resuscitation outcomes, with the American Heart Association recommending their use during advanced life support (ALS). Little is known about the availability of these devices, their protocoled use, and the attitudes toward them in the prehos...
Article
Background: Low-dose, high-frequency CPR training, such as the AHA Resuscitation Quality Improvement program, is designed to prevent skills decay. Preliminary studies have shown success in using gamification- namely a competitive leaderboard - for self-directed CPR training using a feedback-enabled CPR simulator. The purpose of this study was to de...
Article
Background: American Heart Association (AHA) recommends high quality CPR to promote optimal patient outcomes. Few reports compare team members’ perceptions of CPR quality with quantitative CPR data during actual pediatric CPR. Hypothesis: Self-reported team perception of CPR performance will not meet quantitative CPR metrics using AHA BLS guideline...
Article
Full-text available
Background and Objectives Pediatric out‐of‐hospital cardiac arrest survival outcomes are dismal (<10%). Care that is provided in adherence to established guidelines has been associated with improved survival. Lower mortality rates have been reported in higher volume hospitals, teaching hospitals and trauma centers. The primary objective of this pap...
Article
Aim: To determine if integrating a trained CPR Coach into resuscitation teams can improve CPR quality during simulated pediatric cardiopulmonary arrest (CPA). Methods: We conducted a multicenter, prospective, randomized trial. An 18-minute simulated CPA scenario was run for resuscitation teams comprised of CPR-certified professionals from four I...
Article
Objective: We aimed to describe the differences in workload between team leaders and CPR providers during a simulated pediatric cardiac arrest, to evaluate the impact of a CPR feedback device on provider workload, and to describe the association between provider workload and the quality of CPR. Methods: We conducted secondary analysis of data fr...
Article
Background Our purpose was to determine the potential effect of pre‐procedural ultrasound to increase lumbar puncture (LP) success compared with standard palpation method. Further, we assessed feasibility of and clinician satisfaction with a standardized ultrasound protocol. Methods This prospective, two‐arm, parallel group randomized trial was co...
Article
Full-text available
Introduction: We developed a first-person serious game, PediatricSim, to teach and assess performances on seven critical pediatric scenarios (anaphylaxis, bronchiolitis, diabetic ketoacidosis, respiratory failure, seizure, septic shock, and supraventricular tachycardia). In the game, players are placed in the role of a code leader and direct patie...
Article
Full-text available
Introduction: Leaderboards provide feedback on relative performance and a competitive atmosphere for both self-guided improvement and social comparison. Because simulation can provide substantial quantitative participant feedback, leaderboards can be used, not only locally but also in a multidepartment, multicenter fashion. Quick Response (QR) cod...
Article
Objective: We aimed to describe the differences in workload between team leaders and CPR providers during a simulated pediatric cardiac arrest, to evaluate the impact of a CPR feedback device on provider workload, and to describe the association between provider workload and the quality of CPR. Methods: We conducted secondary analysis of data from...
Article
Objectives Paramedics and emergency medical technicians (EMTs) perform triage at disaster sites. There is a need for disaster triage training. Live simulation training is costly and difficult to deliver. Screen‐based simulations may overcome these training barriers. We hypothesized that a screen‐based simulation, 60 Seconds to Survival (60S), would...
Article
Statement: The scope and breadth of simulation-based research is growing rapidly; however, few mechanisms exist for conducting multicenter, collaborative research. Failure to foster collaborative research efforts is a critical gap that lies in the path of advancing healthcare simulation. The 2017 Research Summit hosted by the Society for Simulatio...
Article
Aim: The aim of this study was to assess the validity of a formative feedback instrument for leaders of simulated resuscitations. Methods: This is a prospective validation study with a fully crossed (person × scenario × rater) study design. The Concise Assessment of Leader Management (CALM) instrument was designed by pediatric emergency medicine...
Article
Background: although nurses often place peripheral intravenous (IV) catheters, little is known about their perceptions regarding use of ultrasound guidance. Aim: the authors aimed to determine paediatric emergency department nurses' attitudes toward ultrasound-guided IV access techniques and assessed practice change after training. Method: In a c...
Article
Background: Errors in the timely diagnosis and treatment of infants with hypoglycemic seizures can lead to significant patient harm. It is challenging to precisely measure medical errors that occur during high-stakes/low-frequency events. Simulation can be used to assess risk and identify errors. Objective: We hypothesized that general emergency...
Article
The focused assessment with sonography for trauma (FAST) examination is conducted to rapidly identify bleeding within the abdominal, pericardial, or intrathoracic spaces. The use of the FAST examination is not limited to trauma but is best described in studies involving adults who sustained blunt or penetrating abdominal trauma.¹ Although no clear...
Article
Objectives: Pauses in cardiopulmonary resuscitation negatively impact clinical outcomes; however, little is known about the contributing factors. The objective of this study is to determine the frequency, duration, and causes for pauses during cardiac arrest. Design: This is a secondary analysis of video data collected from a prospective multice...
Article
Introduction: Emergency Medicine Physicians have been incorporating Point-of-Care Ultrasound (POCUS) into their practice for over twenty years. Only recently has its use become more widespread in the practice of Pediatric Emergency Medicine (PEM). Recent guidelines have described the scope of applications for PEM physicians. However, no consensus e...
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Full-text available
Objectives: We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or step...
Article
Objectives: We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or ste...
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Full-text available
Introduction: Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game "60 Seconds to Survival" (60S) would have grea...
Article
The Precision Medicine Initiative spearheaded by the National Institute of Health has pioneered a new model of health care focused on health care delivery that is tailored to an individual. Medical advances have already provided clinicians with the tools to better predict treatment outcomes based on the individual needs of each patient's disease pr...
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Full-text available
Simulation-based research has grown substantially over the past two decades; however, relatively few published simulation studies are multicenter in nature. Multicenter research confers many distinct advantages over single-center studies, including larger sample sizes for more generalizable findings, sharing resources amongst collaborative sites, a...
Article
Objective: The goal of this study was to assess the accuracy of ultrasound-measured optic nerve sheath diameter (ONSD) as a screen for ventriculoperitoneal shunt failure. Methods: We prospectively enrolled a convenience sample of children presenting to the ED with suspected shunt failure. The ONSD was measured by ultrasound and compared with com...

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