Improving patient safety with just-in-time pediatric simulation training

描述（申请人提供）：先进的儿科气道管理对于优化儿童治疗至关重要。我们的长期目标是在先进的儿科气道管理过程中提高患者的安全性。安全的气管插管手术需要在儿科重症监护室（PICU）教授和学习的复杂的个人和多学科团队技能。我们的研究团队使用专门针对儿童的国家紧急气道登记处（NEAR）的强有力的初步数据表明，插管成功和不良事件与很少执行此程序的监督医生实习生有关，他们的表现不如同样监督但经验丰富的尖锐端提供者安全。本研究的目的是评估“即时”模拟过度训练对高级气道管理的安全性和有效性的影响。我们的模拟，高级教育和创新中心开发了模拟工具，提高自我效能，能力和团队沟通。这项前瞻性干预性研究将在儿科ICU中分配用于管理气道紧急情况的尖端供应商随机分为无过度训练组和20分钟的低保真度或高保真度模拟过度训练组，目的有两个：1）评价“即时”模拟过度训练的有效性; 2）评价高保真度与低保真度模拟对患者安全性结局的影响。将使用NEAR工具评价模拟和实际患者气管插管，并将通过我们研究团队开发和验证的技术严格分析首次尝试气管插管成功的主要结局和气管插管相关事件的次要结局。与机构使命的相关性：如果尖端供应商的模拟过度培训能够改善实际患者安全，我们的医院组织将在实践中迅速实施并跟踪这些教育工具的安全影响。提供者、卫生教育工作者、支付者、政策制定者、患者、公众和AHRQ将了解如何在不同的医疗保健环境中改善安全医疗保健的提供。安全先进的儿科气道管理需要经验丰富和训练有素的供应商。如果这项研究表明，模拟过度训练提高了安全性，这些技术将被采用，并在不同的高风险环境中实施，以改善重症儿童的护理。

DESCRIPTION (PROVIDED BY THE APPLICANT): Advanced pediatric airway management is critical for optimized treatment of children. Our long-term goal is to improve patient safety during advanced pediatric airway management. Safe tracheal intubation procedures require sophisticated individual and multidisciplinary team skills that are taught and learned in the pediatric intensive care unit (PICU). Strong preliminary data using the National Emergency Airway Registry (NEAR) specifically adapted for children by our research team demonstrates that intubation success and adverse events are associated with supervised physician trainees who rarely perform this procedure, and their performance is not as safe as identically supervised but experienced sharp end providers. The objective of this proposal is to evaluate the effect of "just-in-time" simulation overtraining on safety and efficacy of advanced airway management. Our Center for Simulation, Advanced Education and Innovation has developed simulation tools that enhance self-efficacy, competence, and team communication. This prospective, interventional study will randomize sharp end providers assigned to manage airway emergencies in the pediatric ICU to either no overtraining versus 20 minutes of either low fidelity or high fidelity simulation overtraining with two specific aims: 1) To evaluate the efficacy of "just-in-time" simulation overtraining; and 2) To evaluate the impact of high versus low fidelity simulation on patient safety outcomes. Both simulated and actual patient tracheal intubations will be evaluated using the NEAR tool, and the primary outcome of tracheal intubation success on first attempt and secondary outcomes of tracheal intubation associated events will be rigorously analyzed by techniques developed and validated by our research team. Relevance to the agency mission: If simulation overtraining of sharp end providers improves actual patient safety, our hospital organization will rapidly implement and track the safety impact of these education tools in practice. Providers, health educators, payers, policy makers, patients, the public and AHRQ would be informed on how to improve the delivery of safe health care across diverse healthcare settings. Safe advanced pediatric airway management requires experienced and trained providers. If this study demonstrates that simulation overtraining improves safety, these techniques will be adopted and implemented in diverse high-risk settings to improve the care of critically ill children.