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Adam Cheng - One of the best experts on this subject based on the ideXlab platform.

  • Cold Debriefings after In-hospital Cardiac Arrest in an International Pediatric Resuscitation Quality Improvement Collaborative.
    Pediatric quality & safety, 2020
    Co-Authors: Heather Wolfe, Vinay M. Nadkarni, Jesse Wenger, Jordan Duval-arnould, Dana Niles, Robert M. Sutton, Roopa Seshadri, Anita I Sen, Adam Cheng
    Abstract:

    Introduction Clinical event debriefing functions to identify optimal and suboptimal performance to improve future performance. "Cold" debriefing (CD), or debriefing performed more than 1 day after an event, was reported to improve patient survival in a single institution. We sought to describe the frequency and content of CD across multiple Pediatric centers. Methods Mixed-methods, a retrospective review of prospectively collected in-hospital cardiac arrest (IHCA) data, and a supplemental survey of 18 international institutions in the Pediatric Resuscitation Quality (pediRES-Q) collaborative. Data from 283 IHCA events reported between February 2016 and April 2018 were analyzed. We used a Plus/Delta framework to collect debriefing content and performed a qualitative analysis utilizing a modified Team Emergency Assessment Measurement Framework. Univariate and regression models were applied, accounting for clustering by site. Results CD occurred in 33% (93/283) of IHCA events. Median time to debriefing was 26 days [IQR 11, 41] with a median duration of 60 minutes [20, 60]. Attendance was variable across sites (profession, number per debriefing): physicians 12 [IQR 4, 20], nurses 1 [1, 6], respiratory therapists 0 [0, 1], and administrators 1 [0, 1]. "Plus" comments reported per event were most commonly clinical standards 47% (44/93), cooperation 29% (27/93), and communication 17% (16/93). "Delta" comments were in similar categories: clinical standards 44% (41/93), cooperation 26% (24/93), and communication 14% (13/93). Conclusions CDs were performed after 33% of cardiac arrests in this multicenter Pediatric IHCA collaborative. The majority of plus and delta comments could be categorized as clinical standards, cooperation and communication.

  • Saving Lives and Improving the Quality of Pediatric Resuscitation Across the World: A 1-Day Research Accelerator Hosted by the International Network for Simulation-based Pediatric Innovation, Research, and Education and the International Pediatric Si
    Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2020
    Co-Authors: David O. Kessler, Vinay M. Nadkarni, Jordan Duval-arnould, Nicole A. Shilkofski, Kimberly Stone, Todd P. Chang, Tom Dolby, Rebecca Gray, Ellen S. Deutsch, Adam Cheng
    Abstract:

    STATEMENT The International Network for Simulation-based Pediatric Innovation, Research, and Education co-hosted a novel research accelerator meeting with the International Pediatric Simulation Society in May of 2019 in Toronto. The purpose of the meeting was to bring together healthcare simulation scientists with Resuscitation stakeholders to brainstorm strategies for accelerating progress in the science of saving Pediatric lives from cardiac arrest. This was achieved by working in teams to draft targeted requests for proposals calling the research community to action investigating this topic. During the 1-day meeting, groups were divided into 6 teams lead by experts representing specific domains of simulation research. Teams developed a pitch and presented a sample request for proposals to a panel of expert judges, making a case for why their domain was the most important to create a funding opportunity. The winner of the competition had their specific request for proposal turned into an actual funding opportunity, supported by philanthropy that was subsequently disseminated through International Network for Simulation-based Pediatric Innovation, Research, and Education as a competitive award. An inspired donor supported an award for the second-place proposal as well, evidence of early research acceleration catalyzed from this conference. This article is a summary of the meeting rationale, format, and a description of the requests for proposals that emerged from the meeting. Our goal is to inspire other stakeholders to use this document that leverages simulation and Resuscitation science expertise, as the framework to create their own funding opportunities, further accelerating Pediatric Resuscitation research, ultimately saving the lives of more children worldwide.

  • Code Team Structure and Training in the Pediatric Resuscitation Quality International Collaborative.
    Pediatric emergency care, 2019
    Co-Authors: Stephen Pfeiffer, Adam Cheng, Kasper G Lauridsen, Jesse Wenger, Elizabeth A. Hunt, Sarah E. Haskell, Dianne L. Atkins, Jordan Duval-arnould, Lynda Knight, Elaine Gilfoyle
    Abstract:

    Objectives Code team structure and training for Pediatric in-hospital cardiac arrest are variable. There are no data on the optimal structure of a Resuscitation team. The objective of this study is to characterize the structure and training of Pediatric code teams in sites participating in the Pediatric Resuscitation Quality Collaborative. Methods From May to July 2017, an anonymous voluntary survey was distributed to 18 sites in the international Pediatric Resuscitation Quality Collaborative. The survey content was developed by the study investigators and iteratively adapted by consensus. Descriptive statistics were calculated. Results All sites have a designated code team and hospital-wide code team activation system. Code team composition varies greatly across sites, with teams consisting of 3 to 17 members. Preassigned roles for code team members before the event occur at 78% of sites. A step stool and backboard are used during Resuscitations in 89% of surveyed sites. Cardiopulmonary Resuscitation (CPR) feedback is used by 72% of the sites. Of those sites that use CPR feedback, all use an audiovisual feedback device incorporated into the defibrillator and 54% use a CPR coach. Multidisciplinary and simulation-based code team training is conducted by 67% of institutions. Conclusions Code team structure, equipment, and training vary widely in a survey of international children's hospitals. The variations in team composition, role assignments, equipment, and training described in this article will be used to facilitate future studies regarding the impact of structure and training of code teams on team performance and patient outcomes.

  • Abstract 17758: Variability in Pediatric Cardiac Arrest Management Across Sites in a Multicenter Pediatric Resuscitation Collaborative
    Circulation, 2017
    Co-Authors: Sholeen Nett, Adam Cheng, Elaine Gilfoyle, Sarah E. Haskell, Dianne L. Atkins, Jordan Duval-arnould, Anita Sen, Ivie Esangbedo, Stuart H. Friess, Dori-ann Martin
    Abstract:

    Introduction: The degree of variability in Pediatric in-hospital cardiac arrest (IHCA) management across institutions is unknown. The Pediatric Quality of Resuscitation collaborative (pediRES-Q), a multi-center group of hospitals collecting data characterizing Resuscitation care, was created to better understand in-hospital Pediatric Resuscitation systems of care. Objective: To characterize the variability of CPR, (pre, during and post) IHCA management and performance across a large network of Pediatric hospitals. Methods: Utilizing a prospective, observational cohort, we analyzed data from Pediatric IHCAs. Data included hospital characteristics, duration of CPR, and chest compression (CC) performance metrics (CC depth, rate and fraction). We also collected details of site participation in components of a Resuscitation QI bundle: high-risk identification checklist, bedside pre-IHCA refreshers, post-IHCA hot and cold debriefings, and a post-IHCA preparation checklist. Results: 135 IHCA events from Oct 2015 to April 2017 were analyzed from 12 participating Pediatric ICUs: median 26 beds (IQR 19, 33), median 1750 admissions/year (IQR 1412, 2327), 75% (9/12) with Pediatric critical care fellowship, median IHCA/year 23 (IQR 20, 29). Marked variability between sites was noted for proportion of IHCAs in which event average CPR perormance data was compliant with 2015 AHA guidelines: CC rate (0-100%), CC depth (43 to 100%), and CC fraction (0 to 100%). Participation in components of the Resuscitation QI bundle for IHCAs varied by site (Figure): 41% (IQR 0, 59) of IHCA were identified beforehand via high risk checklist; 12% (IQR 0, 26) were preceded by recent staff bedside CPR refreshers; 59% (IQR 16, 86) had post-IHCA hot debriefing and 38% (IQR 9, 100) had post-IHCA cold debriefing. Conclusions: Striking variability in elements of Pediatric cardiac arrest Resuscitation management and performance pre-, during and post-IHCA, exist across Pediatric ICUs.

  • The role of simulation in teaching Pediatric Resuscitation: current perspectives.
    Advances in medical education and practice, 2015
    Co-Authors: Yiqun Lin, Adam Cheng
    Abstract:

    The use of simulation for teaching the knowledge, skills, and behaviors necessary for effective Pediatric Resuscitation has seen widespread growth and adoption across Pediatric institutions. In this paper, we describe the application of simulation in Pediatric Resuscitation training and review the evidence for the use of simulation in neonatal Resuscitation, Pediatric advanced life support, procedural skills training, and crisis resource management training. We also highlight studies supporting several key instructional design elements that enhance learning, including the use of high-fidelity simulation, distributed practice, deliberate practice, feedback, and debriefing. Simulation-based training is an effective modality for teaching Pediatric Resuscitation concepts. Current literature has revealed some research gaps in simulation-based education, which could indicate the direction for the future of Pediatric Resuscitation research.

Vinay M. Nadkarni - One of the best experts on this subject based on the ideXlab platform.

  • Cold Debriefings after In-hospital Cardiac Arrest in an International Pediatric Resuscitation Quality Improvement Collaborative.
    Pediatric quality & safety, 2020
    Co-Authors: Heather Wolfe, Vinay M. Nadkarni, Jesse Wenger, Jordan Duval-arnould, Dana Niles, Robert M. Sutton, Roopa Seshadri, Anita I Sen, Adam Cheng
    Abstract:

    Introduction Clinical event debriefing functions to identify optimal and suboptimal performance to improve future performance. "Cold" debriefing (CD), or debriefing performed more than 1 day after an event, was reported to improve patient survival in a single institution. We sought to describe the frequency and content of CD across multiple Pediatric centers. Methods Mixed-methods, a retrospective review of prospectively collected in-hospital cardiac arrest (IHCA) data, and a supplemental survey of 18 international institutions in the Pediatric Resuscitation Quality (pediRES-Q) collaborative. Data from 283 IHCA events reported between February 2016 and April 2018 were analyzed. We used a Plus/Delta framework to collect debriefing content and performed a qualitative analysis utilizing a modified Team Emergency Assessment Measurement Framework. Univariate and regression models were applied, accounting for clustering by site. Results CD occurred in 33% (93/283) of IHCA events. Median time to debriefing was 26 days [IQR 11, 41] with a median duration of 60 minutes [20, 60]. Attendance was variable across sites (profession, number per debriefing): physicians 12 [IQR 4, 20], nurses 1 [1, 6], respiratory therapists 0 [0, 1], and administrators 1 [0, 1]. "Plus" comments reported per event were most commonly clinical standards 47% (44/93), cooperation 29% (27/93), and communication 17% (16/93). "Delta" comments were in similar categories: clinical standards 44% (41/93), cooperation 26% (24/93), and communication 14% (13/93). Conclusions CDs were performed after 33% of cardiac arrests in this multicenter Pediatric IHCA collaborative. The majority of plus and delta comments could be categorized as clinical standards, cooperation and communication.

  • Saving Lives and Improving the Quality of Pediatric Resuscitation Across the World: A 1-Day Research Accelerator Hosted by the International Network for Simulation-based Pediatric Innovation, Research, and Education and the International Pediatric Si
    Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2020
    Co-Authors: David O. Kessler, Vinay M. Nadkarni, Jordan Duval-arnould, Nicole A. Shilkofski, Kimberly Stone, Todd P. Chang, Tom Dolby, Rebecca Gray, Ellen S. Deutsch, Adam Cheng
    Abstract:

    STATEMENT The International Network for Simulation-based Pediatric Innovation, Research, and Education co-hosted a novel research accelerator meeting with the International Pediatric Simulation Society in May of 2019 in Toronto. The purpose of the meeting was to bring together healthcare simulation scientists with Resuscitation stakeholders to brainstorm strategies for accelerating progress in the science of saving Pediatric lives from cardiac arrest. This was achieved by working in teams to draft targeted requests for proposals calling the research community to action investigating this topic. During the 1-day meeting, groups were divided into 6 teams lead by experts representing specific domains of simulation research. Teams developed a pitch and presented a sample request for proposals to a panel of expert judges, making a case for why their domain was the most important to create a funding opportunity. The winner of the competition had their specific request for proposal turned into an actual funding opportunity, supported by philanthropy that was subsequently disseminated through International Network for Simulation-based Pediatric Innovation, Research, and Education as a competitive award. An inspired donor supported an award for the second-place proposal as well, evidence of early research acceleration catalyzed from this conference. This article is a summary of the meeting rationale, format, and a description of the requests for proposals that emerged from the meeting. Our goal is to inspire other stakeholders to use this document that leverages simulation and Resuscitation science expertise, as the framework to create their own funding opportunities, further accelerating Pediatric Resuscitation research, ultimately saving the lives of more children worldwide.

  • Impact of contextualized Pediatric Resuscitation training on Pediatric healthcare providers in Botswana
    Resuscitation, 2014
    Co-Authors: Shelton W. Wright, Andrew P. Steenhoff, Okan U. Elci, Heather Wolfe, Mark Ralston, Thandie Kgosiesele, Ishmael Makone, Loeto Mazhani, Vinay M. Nadkarni, Peter A. Meaney
    Abstract:

    Abstract Background Worldwide, 6.6 million children die each year, partly due to a failure to recognize and treat acutely ill children. Programs that improve provider recognition and treatment initiation may improve child survival. Objectives Describe provider characteristics and hospital resources during a contextualized Pediatric Resuscitation training program in Botswana and determine if training impacts provider knowledge retention. Design/methods The American Heart Association's Pediatric Emergency Assessment Recognition and Stabilization (PEARS) course was contextualized to Botswana resources and practice guidelines in this observational study. A cohort of facility-based nurses (FBN) was assessed prior to and 1-month following training. Survey tools assessed provider characteristics, cognitive knowledge and confidence and hospital Pediatric resources. Data analysis utilized Fisher's exact, Chi-square, Wilcoxon rank-sum and linear regression where appropriate. Results 61 healthcare providers (89% FBNs, 11% physicians) successfully completed PEARS training. Referral facilities had more Pediatric specific equipment and high-flow oxygen. Median frequency of Pediatric Resuscitation was higher in referral compared to district level FBN's (5 [3,10] vs. 2 [1,3] p =0.007). While 50% of FBN's had previous Resuscitation training, none was Pediatric specific. Median provider confidence improved significantly after training (3.8/5 vs. 4.7/5, p p p Conclusion FBN's in Botswana report frequent Resuscitation of ill children but low baseline training. Provider knowledge for recognition and initial treatment of respiratory distress and shock is low. Contextualized training significantly increased FBN provider confidence and knowledge retention 1-month after training.

  • Development and validation of a multiple choice examination assessing cognitive and behavioural knowledge of Pediatric Resuscitation: a report from the EXPRESS Pediatric research collaborative.
    Resuscitation, 2012
    Co-Authors: Jonathan P. Duff, Adam Cheng, Vinay M. Nadkarni, Elizabeth A. Hunt, Louise M. Bahry, Jeffrey Hopkins, Matthew Richard, Steven M. Schexnayder, Mike Carbonaro, Kristen Nelson-mcmillan
    Abstract:

    Abstract Introduction Assessing the knowledge of Pediatric Advanced Life Support (PALS) based learning objectives of medical trainees is an important evaluation component for both residency programs and for research studies. In this study, a multiple-choice question (MCQ) examination was developed and validated for use in a larger Pediatric simulation Resuscitation study (EXPRESS study). Methods Experts in Pediatric Resuscitation developed two MCQ exams using a set of pre-determined learning objectives. After a single center pilot, the exam was used as an assessment of cognitive skills in the EXPRESS study, a multicenter trial examining the use of scripted debriefing and high-fidelity simulation in Pediatric Resuscitation education. Results from the MCQ in the pre-intervention phase of the EXPRESS study were used to assess the reliability and validity of the MCQ examination. In addition, an Exploratory Factor Analysis (EFA) was carried to assess the underlying structure of the PALS-based learning objectives. Results 435 health care professionals completed the MCQ examination with an average score of 69.3%. Significantly higher examination results were seen in physicians vs. non-physicians, senior vs. junior physicians and participants with up-to-date PALS certification. The EFA results indicated four distinct categories of items were assessed. Conclusion This short MCQ examination demonstrated reasonable reliability and construct validity. It may be useful to assess Pediatric Resuscitation knowledge in future studies or courses.

  • express examining Pediatric Resuscitation education using simulation and scripting the birth of an international Pediatric simulation research collaborative from concept to reality
    Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2011
    Co-Authors: Adam Cheng, Aaron Donoghue, Elizabeth A. Hunt, Kristen Nelson, Judy L Leflore, Jodee M Anderson, Walter J Eppich, Robert Simon, Jenny W Rudolph, Vinay M. Nadkarni
    Abstract:

    Abstract:Over the past decade, medical simulation has evolved into an essential component of Pediatric Resuscitation education and team training. Evidence to support its value as an adjunct to traditional methods of education is expanding; however, large multicenter studies are very rare. Simulation

Aaron Donoghue - One of the best experts on this subject based on the ideXlab platform.

  • Abstract 303: The Impact of Pediatric Resuscitation Events on Overall Emergency Department Flow
    Circulation, 2019
    Co-Authors: Peter Mcbride, Matthew Ainsley, Xuemei Zhang, Andrew D. Johnson, Aaron Donoghue, Sage R. Myers
    Abstract:

    Background: Pediatric Resuscitation events are infrequent but resource-intensive events which pull staff, leaving higher patient:provider ratios and less access to the resources in the emergency de...

  • Quality improvement and crisis resource management in Pediatric Resuscitation.
    Current opinion in pediatrics, 2019
    Co-Authors: Sage R. Myers, Aaron Donoghue
    Abstract:

    PURPOSE OF REVIEW The Pediatric Resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in Pediatric Resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change. RECENT FINDINGS Despite the relative difficulty of quality improvement analysis and intervention implementation in the Resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life Resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in Resuscitation. SUMMARY Striving toward a learning healthcare system model in Resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the Resuscitation environment, all providers who could possibly face a Resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.

  • External validation of scoring instruments for evaluating Pediatric Resuscitation.
    Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2014
    Co-Authors: Arielle Levy, Aaron Donoghue, Benoit Bailey, Nathan Thompson, Olivier Jamoulle, Robert Gagnon, Jocelyn Gravel
    Abstract:

    Introduction: Although many methods have been proposed to assess clinical performance during Resuscitation, robust and generalizable metrics are still lacking. Further research is necessary to develop validated clinical performance assessment tools and show an improvement in outcomes after training. We aimed to establish evidence for validity of a previously published scoring instrumentVthe Clinical Performance Tool (CPT)Vdesigned to evaluate clinical performance during simulated Pediatric Resuscitations. Methods: This was a prospective experimental trial performed in the simulation laboratory of a Pediatric tertiary care facility, with a pretest/posttest design that assessed residents before and after Pediatric advanced life support (PALS) certification. Thirteen postgraduate year 1 (PGY1) and 11 PGY3 Pediatric residents completed 5 simulated Pediatric Resuscitation scenarios each during 2 consecutive sessions; between the 2 sessions, they completed a full PALS certification course. All sessions were video recorded. Sessions werescoredbyraters usingtheCPT;totalscoreswereexpressed as a percentage of maximum points possible for each scenario. Validity evidence was established and interpreted according to Messick’s framework. Evidence regarding relations to other variables was assessed by calculating differences in scores between pre-PALS and post-PALS certification and PGY1 and PGY3 using a repeated-measures analysis of variance test. Internal structure evidence was established by assessing interrater reliability using intraclass correlation coefficients (ICCs) for each scenario, a G-study, and a variance component analysis of individual measurement facets (scenarios, raters, and occasions) and associated interactions. Results: Overall scores for the entire study cohort improved by 10% after PALS training. Scores improved by 9.9% (95% confidence interval [CI], 4.5Y15.4) for the pulseless nonshockable arrest (ICC, 0.85; 95% CI, 0.74Y0.92), 14.6% (95% CI, 6.7Y22.4) for the pulseless shockable arrest (ICC, 0.98; 95% CI, 0.96Y0.99), 4.1% (95% CI, j4.5 to 12.8) for the dysrhythmias (ICC, 0.92; 95% CI, 0.87Y0.96), 18.4% (95% CI, 9.7Y27.1) for the respiratory scenario (ICC, 0.97; 95% CI, 0.95Y0.98), and 5.3% (95% CI, j1.4 to 2.0) for the shock scenarios (ICC, 0.94; 95% CI, 0.90Y0.97). There were no differences between PGY1 and PGY3 scores before or after the PALS course. Reliability of the instrument was acceptable as demonstrated by a mean ICC of 0.95 (95% CI, 0.94Y0.96). The G-study coefficient was 0.94. Most variance could be attributed to the subject (57%). Interactions between subject and scenario and subject and occasion were 9.9% and 1.4%, respectively, and variance attributable to rater was minimal (0%). Conclusions: Pediatric residents improved scores on CPT after completion of a PALS course. Clinical Performance Tool scores are sensitive to the increase in skills and knowledge resulting from such a course but not to learners’ levels. Validity evidence from scores for the CPT confirms implementation in new contexts and partially supports internal structure. More evidence is required to further support internal structure and especially to support relations with other variables and consequence evidence. Additional modifications should be made to the CPT before considering its use for high-stakes certification such as PALS. (Sim Healthcare 9:360Y369, 2014)

  • Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing: A Multicenter Randomized Trial
    JAMA pediatrics, 2013
    Co-Authors: Adam Cheng, Aaron Donoghue, Marisa Brett-fleegler, Akira Nishisaki, Elizabeth A. Hunt, Kristen Nelson-mcmillan, Judy L Leflore, Walter J Eppich, Mike Moyer, Monica E. Kleinman
    Abstract:

    Importance Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. Objective To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. Design Prospective, randomized, factorial study design. Setting The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. Participants We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. Intervention Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. Main Outcomes and Measures Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). Results There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes. Conclusions and Relevance The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in Resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.

  • express examining Pediatric Resuscitation education using simulation and scripting the birth of an international Pediatric simulation research collaborative from concept to reality
    Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2011
    Co-Authors: Adam Cheng, Aaron Donoghue, Elizabeth A. Hunt, Kristen Nelson, Judy L Leflore, Jodee M Anderson, Walter J Eppich, Robert Simon, Jenny W Rudolph, Vinay M. Nadkarni
    Abstract:

    Abstract:Over the past decade, medical simulation has evolved into an essential component of Pediatric Resuscitation education and team training. Evidence to support its value as an adjunct to traditional methods of education is expanding; however, large multicenter studies are very rare. Simulation

Linda Quan - One of the best experts on this subject based on the ideXlab platform.

  • increasing Pediatric resident simulated Resuscitation performance a standardized simulation based curriculum
    Resuscitation, 2014
    Co-Authors: Kimberly Stone, Jennifer Reid, Derya Caglar, Ana Christensen, Bonnie Strelitz, Li Zhou, Linda Quan
    Abstract:

    Abstract Aim Studies demonstrating the impact of Resuscitation simulation curricula on performance are limited. Our objective was to create and evaluate a simulation-based Resuscitation curriculum's impact on Pediatric residents’ performance in a simulated Resuscitation. Methods We developed a standardized simulation-based Pediatric resident Resuscitation curriculum consisting of nine modules, incorporating four domains (basic skills, airway/breathing, circulation and team management) and specific topics (e.g., anaphylaxis). Each module was presented four times over the academic year. Evaluation of the curriculum consisted of pre- and post-intervention video-recorded performances of a simulated Pediatric Resuscitation by 10 resident Resuscitation teams, scored using the Simulation Team Assessment Tool (STAT). The effectiveness of the standardized curriculum on medical (basics, airway/breathing, circulation) and team management, and on knowledge test scores was evaluated by comparing pre- and post-intervention STAT scores using unpaired two-sided T-test. The impact of group curriculum participation on team performance (STAT scores) was analyzed using linear regression. Results Overall team performance STAT scores increased post-intervention (mean pre-test 0.61, post-test 0.74, p  Conclusions We created a standardized simulation-based Pediatric Resuscitation curriculum that increased Pediatric residents’ scores on medical management and teamwork skills in a dose dependent relationship.

  • Pediatric Resuscitation AND EMERGENCY MEDICAL SERVICES
    Annals of emergency medicine, 1999
    Co-Authors: Linda Quan
    Abstract:

    Abstract [Quan L: Pediatric Resuscitation and emergency medical services. Ann Emerg Med February 1999;33:214-217.]

  • Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style
    Annals of emergency medicine, 1995
    Co-Authors: Arno Zaritsky, Linda Quan, Vinay M. Nadkarni, Mary Fran Hazinski, George L. Foltin, Jean Wright, Debra Fiser, David Zideman, Patricia J. O'malley, Leon Chameides
    Abstract:

    Abstract [Zaritsky A, Nadkarni V, Hazinski MF, Foltin G, Quan L, Wright J, Fiser D, Zideman D, O'Malley P, Chameides L, Cummins RO: Recommended guidelines for uniform reporting of Pediatric advanced life support: The Pediatric Utstein style. Ann Emerg Med October 1995;26:487-503.] This statement is the product of a task force meeting held June 8, 1994, in Washington DC in conjunction with the First International Conference on Pediatric Resuscitation and a follow-up task force writing group meeting held September 18, 1994, in Chicago. Draft versions of the statement were circulated for comment to all members of the task force, the American Heart Association Subcommittee on Pediatric Resuscitation, and several outside reviewers. This statement and the International Conference on Pediatric Resuscitation were cosponsored by the American Academy of Pediatrics and the American Heart Association. The development of this statement was authorized by the American Academy of Pediatrics; the American Heart Association National Subcommittees on Pediatric Resuscitation, Basic Life Support, and Advanced Cardiac Life Support, the Committee on Emergency Cardiac Care, the Science Advisory Committee; and the European Resuscitation Council. In addition to the writing group, members of the Pediatric Utstein Task Force are Paul Anderson, M Douglas Baker, Jane Ball, Desmond Bohn, Dena Brownstein, J Michael Dean, Niranjan Kissoon, Bruce Klein, Patrick Malone, Karin McCloskey, James McCrory, P Pearl O'Rourke, Mary Patterson, Charles Schleien, James Seidel, Joseph J Tepas III, and Becky Yano.

  • Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style
    Resuscitation, 1995
    Co-Authors: Arno Zaritsky, Linda Quan, Vinay M. Nadkarni, Mary Fran Hazinski, George L. Foltin, Jean Wright, Debra Fiser, David Zideman, Patricia J. O'malley, Leon Chameides
    Abstract:

    This statement is the product of a task force meeting held June 8, 1994, in Washington, DC, in conjunction with the First International Conference on Pediatric Resuscitation, and a follow-up task force writing group meeting held September 18, 1994, in Chicago, Ill. Draft versions of the statement were circulated for comment to all members of the task force, the AHA Subcommittee on Pediatric Resuscitation, and several outside reviewers. This statement and the International Conference on Pediatric Resuscitation were cosponsored by the American Academy of Pediatrics and the American Heart Association. The development of this statement was authorized by the American Academy of Pediatrics; the AHA National Subcommittees on Pediatric Resuscitation, Basic Life Support, and Advanced Cardiac Life Support, the Committee on Emergency Cardiac Care, the Science Advisory Committee; and the European Resuscitation Council. In addition to the writing group, members of the Pediatric Utstein Task Force are Paul Anderson, M. Douglas Baker, Jane Ball, Desmond Bohn, Dena Brownstein, J. Michael Dean, Niranjan Kissoon, Bruce Klein, Patrick Malone, Karin McCloskey, James McCrory, P. Pearl O’Rourke, Mary Patterson, Charles Schleien, James Seidel, Joseph J. Tepas III, and Becky Yano. Pediatric patients receiving Resuscitation have a high mortality and morbidity.1,2 To help improve this situation, the American Heart Association and the American Academy of Pediatrics developed guidelines for Pediatric Resuscitation3 and an educational program, “Pediatric Advanced Life Support.”4 Ideally, these guidelines and programs should be based on published, well-controlled research in which objective data were used to evaluate progress in treatment of cardiac arrest, acute respiratory failure, and acute circulatory failure. Unfortunately, because children receive Resuscitation infrequently, such data are often lacking, few large studies are available, and the lack of common terminology and methodology makes it impossible to combine smaller studies or compare published results from different centers. Moreover, …

Elizabeth A. Hunt - One of the best experts on this subject based on the ideXlab platform.

  • Code Team Structure and Training in the Pediatric Resuscitation Quality International Collaborative.
    Pediatric emergency care, 2019
    Co-Authors: Stephen Pfeiffer, Adam Cheng, Kasper G Lauridsen, Jesse Wenger, Elizabeth A. Hunt, Sarah E. Haskell, Dianne L. Atkins, Jordan Duval-arnould, Lynda Knight, Elaine Gilfoyle
    Abstract:

    Objectives Code team structure and training for Pediatric in-hospital cardiac arrest are variable. There are no data on the optimal structure of a Resuscitation team. The objective of this study is to characterize the structure and training of Pediatric code teams in sites participating in the Pediatric Resuscitation Quality Collaborative. Methods From May to July 2017, an anonymous voluntary survey was distributed to 18 sites in the international Pediatric Resuscitation Quality Collaborative. The survey content was developed by the study investigators and iteratively adapted by consensus. Descriptive statistics were calculated. Results All sites have a designated code team and hospital-wide code team activation system. Code team composition varies greatly across sites, with teams consisting of 3 to 17 members. Preassigned roles for code team members before the event occur at 78% of sites. A step stool and backboard are used during Resuscitations in 89% of surveyed sites. Cardiopulmonary Resuscitation (CPR) feedback is used by 72% of the sites. Of those sites that use CPR feedback, all use an audiovisual feedback device incorporated into the defibrillator and 54% use a CPR coach. Multidisciplinary and simulation-based code team training is conducted by 67% of institutions. Conclusions Code team structure, equipment, and training vary widely in a survey of international children's hospitals. The variations in team composition, role assignments, equipment, and training described in this article will be used to facilitate future studies regarding the impact of structure and training of code teams on team performance and patient outcomes.

  • Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing: A Multicenter Randomized Trial
    JAMA pediatrics, 2013
    Co-Authors: Adam Cheng, Aaron Donoghue, Marisa Brett-fleegler, Akira Nishisaki, Elizabeth A. Hunt, Kristen Nelson-mcmillan, Judy L Leflore, Walter J Eppich, Mike Moyer, Monica E. Kleinman
    Abstract:

    Importance Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. Objective To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. Design Prospective, randomized, factorial study design. Setting The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. Participants We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. Intervention Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. Main Outcomes and Measures Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). Results There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes. Conclusions and Relevance The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in Resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.

  • Development and validation of a multiple choice examination assessing cognitive and behavioural knowledge of Pediatric Resuscitation: a report from the EXPRESS Pediatric research collaborative.
    Resuscitation, 2012
    Co-Authors: Jonathan P. Duff, Adam Cheng, Vinay M. Nadkarni, Elizabeth A. Hunt, Louise M. Bahry, Jeffrey Hopkins, Matthew Richard, Steven M. Schexnayder, Mike Carbonaro, Kristen Nelson-mcmillan
    Abstract:

    Abstract Introduction Assessing the knowledge of Pediatric Advanced Life Support (PALS) based learning objectives of medical trainees is an important evaluation component for both residency programs and for research studies. In this study, a multiple-choice question (MCQ) examination was developed and validated for use in a larger Pediatric simulation Resuscitation study (EXPRESS study). Methods Experts in Pediatric Resuscitation developed two MCQ exams using a set of pre-determined learning objectives. After a single center pilot, the exam was used as an assessment of cognitive skills in the EXPRESS study, a multicenter trial examining the use of scripted debriefing and high-fidelity simulation in Pediatric Resuscitation education. Results from the MCQ in the pre-intervention phase of the EXPRESS study were used to assess the reliability and validity of the MCQ examination. In addition, an Exploratory Factor Analysis (EFA) was carried to assess the underlying structure of the PALS-based learning objectives. Results 435 health care professionals completed the MCQ examination with an average score of 69.3%. Significantly higher examination results were seen in physicians vs. non-physicians, senior vs. junior physicians and participants with up-to-date PALS certification. The EFA results indicated four distinct categories of items were assessed. Conclusion This short MCQ examination demonstrated reasonable reliability and construct validity. It may be useful to assess Pediatric Resuscitation knowledge in future studies or courses.

  • express examining Pediatric Resuscitation education using simulation and scripting the birth of an international Pediatric simulation research collaborative from concept to reality
    Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2011
    Co-Authors: Adam Cheng, Aaron Donoghue, Elizabeth A. Hunt, Kristen Nelson, Judy L Leflore, Jodee M Anderson, Walter J Eppich, Robert Simon, Jenny W Rudolph, Vinay M. Nadkarni
    Abstract:

    Abstract:Over the past decade, medical simulation has evolved into an essential component of Pediatric Resuscitation education and team training. Evidence to support its value as an adjunct to traditional methods of education is expanding; however, large multicenter studies are very rare. Simulation

  • Simulated Pediatric Resuscitation use for personal protective equipment adherence measurement and training during the 2009 influenza (H1N1) pandemic.
    Joint Commission journal on quality and patient safety, 2011
    Co-Authors: Christopher M. Watson, Jordan Duval-arnould, Michael C. Mccrory, Stephan Froz, Cheryl Connors, Trish M. Perl, Elizabeth A. Hunt
    Abstract:

    Article-at-a-Glance Background Previous experience with simulated Pediatric cardiac arrests (that is, mock codes) suggests frequent deviation from American Heart Association (AHA) basic and advanced life support algorithms. During highly infectious outbreaks, acute Resuscitation scenarios may also increase the risk of insufficient personal protective equipment (PPE) use by health care workers (HCWs). Simulation was used as an educational tool to measure adherence with PPE use and Pediatric Resuscitation guidelines during simulated cardiopulmonary arrests of 2009 influenza A patients. Methods A retrospective, observational study was performed of 84 HCWs participating in 11 in situ simulations in June 2009. Assessment included (1) PPE adherence, (2) confidence in PPE use, (3) elapsed time to specific Resuscitation maneuvers, and (4) deviation from AHA guidelines. Results Observed adherence with PPE use was 61% for eye shields, 81% for filtering facepiece respirators or powered air-purifying respirators, and 87% for gown/gloves. Use of a "gatekeeper" to control access and facilitate donning of PPE was associated with 100% adherence with gown and respirator precautions and improved respirator adherence. All simulations showed deviation from Pediatric basic life support protocols. The median time to bag-valve-mask ventilation improved from 4.3 to 2.7minutes with a gatekeeper present. Rapid isolation carts appeared to improve access to necessary PPE. Confidence in PPE use improved from 64% to 85% after the mock code and structured debriefing. Conclusions Large gaps exist in the use of PPE and self-protective behaviors, as well as adherence to Resuscitation guidelines, during simulated Resuscitation events. Intervention opportunities include use of rapid isolation measures, use of gatekeepers, reinforcement of first responder roles, and further simulation training with PPE.