Use of Simulation to Test Systems and Prepare Staff for a New Hospital Transition.

OBJECTIVE: To describe the development and key outcomes arising from the use of simulation as a method to test systems and prepare staff for a transition to a new hospital. METHODS: We describe a simulation program developed by key parties with the goal of reducing latent safety threats present at the opening of a new hospital and to train staff in new workflows. Issues identified were collected and reported to leadership. Outcomes included the number of learners reached, issues identified (grouped by theme), and results of a postmove survey of hospital-based staff. RESULTS: Approximately 258 hours of simulation were conducted, impacting 514 participants. We conducted 64 hours of system testing and 196 hours of training during the main orientation process. Approximately 641 unique issues were identified (175 equipment, 136 code alarm, 174 barriers to care, and 156 incorrect signage). In a hospital-wide survey, 38% reported simulation as part of their training (39% of nurses and 23% of physicians). 43% of survey respondents reported multidisciplinary simulations; 55% of simulation attendees felt that the simulation was helpful and eased their transition to the new hospital. CONCLUSIONS: Systems testing and education using simulation can play a meaningful role in new facility training. Key lessons included early planning, allocation of resources to the effort, flexibility to adapt to changes, and planned integration with other training activities. A formal a priori plan to address issues identified during the process is necessary.

Development and Evaluation of a Learning Intervention Targeting First-Year Resident Defibrillation Skills.

OBJECTIVES: The aim of the study was to evaluate an educational intervention targeting the acquisition and retention of critical core skills of defibrillation in first-year pediatric residents using simulation-based training and deliberate practice. METHODS: From January 2011 to April 2012, a total of 23 first-year pediatric residents participated in a pretest-posttest study. An initial survey evaluated previous experience, training, and comfort. The scoring tool was designed and validated using a standard setting procedure and 60% was determined to be the minimum passing score. The 1-hour educational intervention included a brief video describing the defibrillator, 10 to 15 minutes of hands-on time with the defibrillator, and 30 minutes of simulation-based scenarios using deliberate practice with real-time feedback. RESULTS: The number of subjects who achieved competency in defibrillation skills increased from 8 to 16 of 23 (35% vs 70%, P < 0.05), pretest versus posttest, with the posttest occurring 4 months after the intervention. There was a significant improvement in checklist score (53% vs 68%, P < 0.05) and time to defibrillation (282-189 s, P < 0.05). For those who initiated chest compressions, there was a nonsignificant improvement in time to compressions (50 vs 33 s, P = 0.08). Previous Pediatric Advanced Life Support training was not associated with performance on pretest or posttest. CONCLUSIONS: This brief educational intervention was shown to be effective 4 months after instruction in achieving and retaining competency of defibrillation skills by first-year pediatric residents. In the process, we uncovered educational gaps in cardiopulmonary resuscitation and other resuscitation skills that need to be addressed in future educational interventions and training.

Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents.

BACKGROUND: Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes. OBJECTIVE: To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE. METHODS: Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE. RESULTS: No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n=30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention. CONCLUSIONS: A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols.