A Statewide Collaboration to Deliver and Evaluate a Pediatric Critical Care Simulation Curriculum for Emergency Medical Services.
A Statewide Collaboration to Deliver and Evaluate a Pediatric Critical Care Simulation Curriculum for Emergency Medical Services.
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DOI：
10.3389/fped.2022.903950
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发表时间：
2022
影响因子：
2.6
通讯作者：
Chung, Sarita
中科院分区：
文献类型：
--
作者：
Farrell, Caitlin;Dorney, Kate;Mathews, Bonnie;Boyle, Tehnaz;Kitchen, Anthony;Doyle, Jeff;Monuteaux, Michael C.;Li, Joyce;Walsh, Barbara;Nagler, Joshua;Chung, Sarita
关键词：
对于紧急医疗服务（EMS）提供者来说，重症儿童的护理是一种罕见但有压力的事件。模拟训练可以改善复苏护理和院前结果，但有限的专家，模拟设备和成本限制了EMS系统的采用。我们的目标是形成一个全州范围内的合作，开发，交付和评估儿科重症监护模拟课程的EMS供应商。我们描述了五个学术中心之间的全州范围内的合作，开发模拟课程，并将其交付给EMS供应商。案例是由合作PEM教师，EMS区域主任审查，并根据以前出版的EMS课程，全州范围内的需求评估，并更新状态EMS协议。模拟课程包括3个场景，需要对危重婴儿和儿童进行识别和紧急管理。该课程是通过5个单独的教育会议，在每个站点由一名教师领导，在6个月的时间内实施。我们评估了课程的有效性与前瞻性，干预性，单臂教育研究使用前后评估设计，以评估EMS供应商的知识和信心的影响。为了评估干预对知识得分的影响，同时考虑嵌套数据，我们估计了一个混合效应广义回归模型，该模型对地区和参与者具有随机效应。我们在课程结束后6个月评估了知识保留和自我报告的实践变化。使用框架方法对课程结束后和6个月随访时参与者的书面答复进行定性分析。总体而言，78名紧急医疗技术人员（EMT）和109名护理人员在五个单独的课程中参加了课程。大多数参与者是男性（69%）和护理人员（58%）。三分之一有15年以上的临床经验。在回归分析中，平均儿科知识得分增加了9.8%（95% CI：7.2%，12.4%）。大多数（93% [95% CI：87.2%，96.5%]）参与者报告对儿科患者的护理信心有所提高。虽然后续的反应是有限的，参与者谁完成了后续调查报告说，他们在临床实践中使用的课程中获得的技能。通过全州范围内的合作，我们为EMS提供者提供了儿科重症监护模拟课程，影响了参与者对儿科患者的知识和信心。后续数据表明，作为课程一部分获得的知识和技能已转化为实践。这一战略可用于未来的努力，将模拟纳入EMS的做法。
Care 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. We 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. Overall, 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. Through 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.
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