Critical Procedure Skill Maintenance Through Simulation Based Curriculum in Pediatric Intensive Care Unit and Pediatric Emergency Medicine

Shuang Li; Jennifer Setlik

doi:10.1542/peds.141.1_MeetingAbstract.322

INTRODUCTION: Critical procedural skill proficiency and maintenance present concerns for the quality of care in pediatric patient population. Previous studies have shown that simulation-based training improved physician performance and led to favorable patient outcomes. We evaluated the need for simulation-based curriculum specific to the cohort of pediatric critical care and emergency attending physicians. METHODS: Attending physicians from pediatric emergency medicine and intensive care unit rotated through simulation-based training for thoracotomy and cricothyrotomy. Prior to education, physicians performed each procedure on mannequins using standard kits. Performance was evaluated against procedure-specific checklists. Physician confidence was assessed via survey. Statistical analysis was performed using SPSS version 23.0 software (IBM, Armonk, NY). RESULTS: 13 physicians participated in this study, 12 performed thoracotomy and 11 performed cricothyrotomy via simulation. 15.4% of the physicians felt completely confident in performing thoracotomy, and none of the physicians felt completely confident in cricothyrotomy. For thoracotomy, 8.3% of physicians completed all items on the checklist, and on average physicians had an 86.7% completion rate. For cricothyrotomy, no one completed all items on the checklist, and on average physicians had a 62.5% completion rate. The median times to perform thoracotomy and cricothyrotomy are 228 seconds (range=148-487s) and 84s (range=43-158s) respectively. CONCLUSION: Physicians in emergency medicine and critical care lack confidence and skills in performing critical procedures such as thoracotomy and cricothyrotomy due to deficiency of practice in the clinical setting. Simulation-based curriculum can effectively improve physician confidence level and maintain proficiency in such low-frequency high-risk procedures.