422 - Are You My Mother? Simulations for improving the reunification process

Publication Number: 422.3639

Erica Popovsky, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jennifer Y. Colgan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Maureen Bentley, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Laura Morales, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Susan B. Ruohonen, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Sally L. Reynolds, Lurie Children’s, Chicago, IL, United States

Background: Pediatric mass casualty incidents (MCIs) are low-frequency, high-stakes events with the potential influx of injured, unaccompanied children to the emergency department (ED). These children may be critically injured or developmentally unable to self-identify or provide caregiver information. Hospitals also face the arrival of worried families searching for their child. To reunite children with their families and manage concerned caregivers, reunification plans need to be user-friendly and operationally sound. The Emergency Management team at Lurie Children’s Hospital identified that the existing Family Services Reunification Policy (FSRP) required more defined roles and responsibilities and evaluation in a simulation setting.

Objective: Global aim: To standardize roles and responsibilities for reunification during a disaster by July 2024.
SMART aim: To update and utilize job action sheets (JAS) for successful family reunification in a disaster by July 2024, improving process initiation, photo identification, and opening a family reunification center (FRC).

Design/Methods: This was a QI initiative using simulations as PDSA cycles. Our team included members from Emergency Management, ED physicians, Family Services (FS) and the KidSTAR Simulation program. Simulation participants included FS leadership, social workers, chaplains, child life, interpreters and security officers. We facilitated 3 reunification simulations: 1 tabletop drill and 2 small-scale exercises, each one increasing in complexity, with the third simulation including parent actors looking to reunite with their children. We then evaluated the FSRP during a full-scale hospital-wide mass casualty exercise including live patient and parent actors. Identified areas for improvement were tracked using after action reports and implemented prior to the next simulation.

Results: Each PDSA cycle identified existing areas of strength and multiple barriers. The improvements included photo documentation methods and education including a downtime alternative, updated JAS to delineate roles/responsibilities, and alternative FRC locations. FS staff noted increasing comfort adhering to the FSRP.

Conclusion(s): Pediatric reunification is a key aspect of an MCI, but difficult to simulate. FS staff may be uncomfortable in high-acuity events and expect concrete direction from the MCI leaders. Dedicated drills focusing on the FSRP resulted in improvements to the JAS, which are key visual aids during these stressful events. Our simulations uncovered multiple barriers and led to key equipment changes for photo identification of unaccompanied children.

Figure 1: Photo Collection Process Improvement
Example barriers to photo collection and improvements

Table 1: Improvements Implemented Based on Barriers Identified During Reunification Drills


Figure 1: Photo Collection Process Improvement
Example barriers to photo collection and improvements

Table 1: Improvements Implemented Based on Barriers Identified During Reunification Drills