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ICU Emergencies Simulation Curriculum for Critical Care Fellows: The Difficult Airway.

ABSTRACT: Introduction:Management of airway emergencies is a core skill for critical care fellows. There is no standardized training mechanism for difficult airway management among critical care fellowships, although fellows frequently cite management of airway catastrophes as an area of educational need. Methods:Three simulation cases that are each approximately 15 minutes in length are presented. The cases represent airway emergencies encountered in the intensive care unit consisting of angioedema, endotracheal tube dislodgement, and endotracheal tube occlusion. Incorporated into the scenarios are planned incidents of interpersonal conflict requiring negotiation by the learner during a crisis event. The case descriptions are complete, with learning objectives and critical actions as well as all necessary personnel briefs and required equipment. Results:The cases were completed over multiple simulation sessions on different days by 11 first-year critical care fellows during the 2016-2017 academic year. All participants demonstrated improvement in self-perceived confidence in airway management skills. Discussion:The cases were felt to be realistic and beneficial and led to perceived improvement in management of airway emergencies and leadership during crisis scenarios.

SUBMITTER: Keller JM

PROVIDER: S-EPMC6346282 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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ICU Emergencies Simulation Curriculum for Critical Care Fellows: The Difficult Airway.

Keller Jonathan M JM Steinbach Trevor C TC Adamson Rosemary R Carlbom David J DJ Johnson Nicholas J NJ Clark Jennifer J Kritek Patricia A PA Çoruh Başak B

MedEdPORTAL : the journal of teaching and learning resources 20180824

<h4>Introduction</h4>Management of airway emergencies is a core skill for critical care fellows. There is no standardized training mechanism for difficult airway management among critical care fellowships, although fellows frequently cite management of airway catastrophes as an area of educational need.<h4>Methods</h4>Three simulation cases that are each approximately 15 minutes in length are presented. The cases represent airway emergencies encountered in the intensive care unit consisting of a ...[more]

PMID: 30800944

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Project description:IntroductionThis 3-hour simulation module provides a safe situation for neonatal-perinatal fellows to learn communication techniques and develop skills for delivering difficult news to patients' families. These skills are critical for a practicing neonatologist in an academic or private-practice setting yet are often underrepresented in the educational content of training programs. This module is intended for fellows who have had basic communication skills instruction, as well as interactions with parents as part of their pediatric residency training.MethodsThe fellows practice delivering difficult news by interacting with standardized parents in scenarios designed for one to three learners at a time. Each scenario runs for approximately 10 to 15 minutes and is followed by a 25- to 30-minute debriefing. Those not participating in the scenario view the simulation in real-time video broadcast from another room so they can learn from the scenario and participate in the debriefing. The module also includes 10 to 15 minutes for discussion of literature. This publication includes an introductory slide presentation and a comprehensive compilation of communication recommendations from attending neonatologists. Also included are scripts for the standardized parents, background information for learners, guidelines and suggestions for discussion during the debriefing, and an evaluation form.ResultsThis module has been incorporated into the yearly simulation curriculum for our neonatal-perinatal fellowship. After completing the module, fellows have reported feeling more comfortable with delivering difficult news. The average score in fellows' comfort level for having these conversations rose from 5.8 to 7.5 on a 10-point scale.DiscussionThis module was designed for use in a perinatal-neonatal fellowship training program, but it could be used in all pediatric residencies, as well as for support staff training (social work, nursing, chaplaincy) with the use of a confederate physician.

Project description:ObjectiveCare of the critically ill child is a rare but stressful event for emergency medical services (EMS) providers. Simulation training can improve resuscitation care and prehospital outcomes but limited access to experts, simulation equipment, and cost have limited adoption by EMS systems. Our objective was to form a statewide collaboration to develop, deliver, and evaluate a pediatric critical care simulation curriculum for EMS providers.MethodsWe describe a statewide collaboration between five academic centers to develop a simulation curriculum and deliver it to EMS providers. Cases were developed by the collaborating PEM faculty, reviewed by EMS regional directors, and based on previously published EMS curricula, a statewide needs assessment, and updated state EMS protocols. The simulation curriculum was comprised of 3 scenarios requiring recognition and acute management of critically ill infants and children. The curriculum was implemented through 5 separate education sessions, led by a faculty lead at each site, over a 6 month time period. We evaluated curriculum effectiveness with a prospective, interventional, single-arm educational study using pre-post assessment design to assess the impact on EMS provider knowledge and confidence. To assess the intervention effect on knowledge scores while accounting for nested data, we estimated a mixed effects generalized regression model with random effects for region and participant. We assessed for knowledge retention and self-reported practice change at 6 months post-curriculum. Qualitative analysis of participants' written responses immediately following the curriculum and at 6 month follow-up was performed using the framework method.ResultsOverall, 78 emergency medical technicians (EMTs) and 109 paramedics participated in the curriculum over five separate sessions. Most participants were male (69%) and paramedics (58%). One third had over 15 years of clinical experience. In the regression analysis, mean pediatric knowledge scores increased by 9.8% (95% CI: 7.2%, 12.4%). Most (93% [95% CI: 87.2%, 96.5%]) participants reported improved confidence caring for pediatric patients. Though follow-up responses were limited, participants who completed follow up surveys reported they had used skills acquired during the curriculum in clinical practice.ConclusionThrough statewide collaboration, we delivered a pediatric critical care simulation curriculum for EMS providers that impacted participant knowledge and confidence caring for pediatric patients. Follow-up data suggest that knowledge and skills obtained as part of the curriculum was translated into practice. This strategy could be used in future efforts to integrate simulation into EMS practice.

Project description:While treating potentially violent patients in the emergency department (ED), both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a team-based approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1) to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2) to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design.Formal roles and responsibilities for each member of the care team, including positioning during restraint placement, were predefined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs) and structured debriefing. The study consisted of a survey-based design comparing pre- and post-intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS) consisting of 30 Likert-scale questions grouped into four themed constructs.One hundred sixty-two ED staff members completed the course with >95% staff participation, generating a total of 106 paired surveys. Constructs for internal/biomedical factors, external/staff factors and situational/interactional perspectives on patient aggression significantly improved (p<0.0001, p<0.002, p<0.0001 respectively). Staff attitudes toward management of patient aggression did not significantly change (p=0.542). Multiple quality improvement initiatives were successfully implemented, including the creation of an interprofessional crisis management alert and response protocol. Staff members described appreciation for our simulation-based curriculum and welcomed the interaction with SPs during their training.A structured simulation-enhanced interprofessional intervention was successful in improving multiple facets of ED staff attitudes toward behavioral emergency care.

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ICU Emergencies Simulation Curriculum for Critical Care Fellows: The Difficult Airway.

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ICU Emergencies Simulation Curriculum for Critical Care Fellows: The Difficult Airway.

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