Thursday, July 2, 2015

Development and Implementation of a Patient Safety Curriculum in a Pediatric Emergency Department

Mary Patterson, MD, MEd
Cincinnati Children's Hospital Medical Center
The 1999 Institute of Medicine report, To Err is Human, identified the mergency department (ED) as the area of the hospital with the highest risk of adverse events. In one study of adult emergency medicine claims, teamwork failures accounted for almost half of the cases. The purpose of this project is to improve teamwork and communication skills among staff and physicians in a pediatric ED by having the ED teams learn and practice these skills with a pediatric patient simulator in a simulated ED. The overall goal of this project is to decrease and mitigate the effects of medical error in a pediatric emergency department through the implementation of a multidisciplinary, simulation-based safety curriculum that emphasizes team behaviors.
Experiential learning theory served as the basis for his project. Simulation training has proven effective in improving communication and teamwork in other high risk industries such as aviation and nuclear energy. This paper describes the development and implementation of this pilot project and the subsequent formative evaluation of the curriculum. Specifically, a senior physician, a fellow, three nurses, one paramedic and one patient care assistant comprised the pilot multidisciplinary team. These individual attended the one and a half day curriculum. Knowledge, attitudes and behavior were assessed prior to and immediately following the intervention. Immedate short term gains were measured in knowledge and some aspects of attitude. It was less clear that behaviors were immediately impacted, though qualitative evidence suggests that behaviors were affected.
All care providers, including residents, in our pediatric ED will eventually participate in this intervention. Knowledge and attitudes are assessed prior to and following the intervention. In addition videotapes of simulated patient scenarios are evaluated for change in teamwork behaviors.
ED personnel will return for reassessment in the simulation lab every sixe months and actual resuscitations in the ED are also videotaped and assessed for teamwork behaviors. This project is unique in its setting, a pediatric ED, and its inclusion of all care providers as well as residents in training. The specific aims of this proposal are:
  1. To implement a multidisciplinary simulation-based safety curriculum that encompasses crew resource management, teamwork behaviors and critical communication skills.
  2. To evaluate the effectiveness of this curriculum by assessing knowledge of and attitudes toward patient safety among caregivers prior to and following this intervention.
  3. To evaluate the effectiveness of this training by assessment teamwork behaviors in a simulated setting prior to and following an intervention.
  4. To evaluate the transfer of the skills learned in a simulated setting to the ED environment by evaluation of teamwork skills in actual critical emergency department patients.
By improving teamwork and communication skills among caregivers, the care of critically ill and injured pediatric patients will be improved and safer.