Using simulation to teach paediatric complex care.

BACKGROUND: Training paediatric residents regarding the care of children with medical complexity (CMC) remains an important challenge given how frequently these patients are treated by trainees and the lack of educational activities specific to these patients. Our goal was to develop and assess a novel simulation regarding the acute care of CMC to improve residents' perceived confidence in areas related to CMC care. APPROACH: We developed a case of a patient with multiple chronic medical conditions who presented with acute vital sign changes and worsening discomfort due to an occult femur fracture related to a recent transfer. Paediatric residents worked in teams to complete a full physical exam, create a differential diagnosis, evaluate laboratory and imaging results and create a management plan. EVALUATION: Thirty-three residents out of a total possible sample of 97 (34%) participated in the simulation, which was evaluated using pre- and post-surveys immediately before and after the simulation assessing resident confidence completing tasks related to CMC care. Residents perceived significant improvement in confidence regarding evaluating a differential diagnosis of vital sign and exam changes in CMC (p = 0.023), managing vital sign and exam changes in CMC (p = 0.009) and communicating with team members of CMC (p = 0.049). IMPLICATIONS: An innovative high-fidelity and low-stakes simulation was effective in teaching trainees about acute management of concerns related to CMC. This simulation may be appropriate for implementation at other institutions, serving as a foundation for use in resident education regarding CMC.

Access to Home- and Community-Based Services for Children with Disability: Academic Institutions' Role and Areas for Improvement.

OBJECTIVE: This project sought to describe provider- and parent-identified needs and barriers to obtaining home- and community-based services (HCBS) for children with disability (CWD) and to determine ways pediatric health care institutions can improve access to HCBS services. METHODS: In this exploratory sequential mixed methods evaluation, semi-structured interviews and focus groups were conducted with multidisciplinary providers and staff from an independent children's hospital, followed by a survey of English and Spanish-speaking parents of CWD. Data from interviews and surveys were then triangulated for overarching common themes regarding how pediatric health care institutions can better support access to HCBS. RESULTS: Among 382 parent respondents, 74.1% reported that their child needed a HCBS, most commonly physical/occupational/speech therapies, school-based support, and case management services. Two-thirds of parents reported at least one barrier to accessing HCBS and one-third experience >3 barriers. While multiple current institutional strengths were noted, internal weaknesses included lack of provider knowledge, staffing difficulties, and lack of protocols for identifying and tracking patients needing or receiving HCBS. External threats included requirements to entry for HCBS and transfer of care, with opportunities for improvement involving dissemination of information, funding support, and connection between providers/support staff and services. CONCLUSIONS: Parents of CWD identified HCBS as necessary for the health of this population, but multiple barriers to HCBS were identified by both parents and providers. Multiple internal and external opportunities for improvement relative to pediatric health care institutions were identified, suggesting a need for a comprehensive approach to ensure that CWD receive necessary HCBS.