Simulation of pediatric trauma stabilization in 35 North Carolina emergency departments: Identification of targets for performance improvement

Department of Surgery, Duke University, Durham, North Carolina, United States
PEDIATRICS (Impact Factor: 5.47). 04/2006; 117(3):641-8. DOI: 10.1542/peds.2004-2702
Source: PubMed


Trauma is the leading cause of death in children. Most children present to community hospital emergency departments (EDs) for initial stabilization. Thus, all EDs must be prepared to care for injured children. The objectives of this study were to (1) characterize the quality of trauma stabilization efforts in EDs and (2) identify targets for educational interventions.
This was a prospective observational study of simulated trauma stabilizations, that is, "mock codes," at 35 North Carolina EDs. An evaluation tool was created to score each mock code on 44 stabilization tasks. Primary outcomes were (1) interrater reliability of tool, (2) overall performance by each ED, and (3) performance per stabilization task.
Evaluation-tool interrater reliability was excellent. The median number of stabilization tasks that needed improvement by the EDs was 25 (57%) of 44 tasks. Although problems were numerous and varied, many EDs need improvement in tasks uniquely important and/or complicated in pediatric resuscitations, including (1) estimating a child's weight (17 of 35 EDs [49%]), (2) preparing for intraosseous needle placement (24 of 35 [69%]), (3) ordering intravenous fluid boluses (31 of 35 [89%]), (4) applying warming measures (34 of 35 [97%]), and (5) ordering dextrose for hypoglycemia (34 of 35 [97%]).
This study used simulation to identify deficiencies in stabilization of children presenting to EDs, revealing that mistakes are ubiquitous. ED personnel were universally receptive to feedback. Future research should investigate whether interventions aimed at improving identified deficiencies can improve trauma stabilization performance and, ultimately, the outcomes of children who present to EDs.

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    • "Simulation performed within a clinical enviroment, in situ simulation, is particularly suitable to identify system weaknesses or errors and to perform context-sensitive assessments. By bringing simulation into the clinical enviroment, it is possible to identify and prevent adverse events that could compromise patient safety [20-22]. Furthermore, in situ simulation represents a cost-effective opportunity in medical education and several studies report the utility of simulation training for acquisition of skills and knowledge with retention across different specialities [23-25]. "
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    • "A study of simulated mock traumas performed at 35 North Carolina emergency departments revealed problems with pediatric-specific tasks, such as appropriate use of intraosseous needles, weight-based dextrose and volume replacement, and poor preparation for transport to CT. In this study, teams were 315 SIMULATION AND TEAMWORK evaluated to identify possible targets for educational and system-wide interventions that might have the potential to improve the outcomes of pediatric trauma victims [47]. "
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