492 - Simulation experience improves resident confidence with escalating pediatric patient care

Publication Number: 492.6730

Charles A. Coomer, Boston Children's Hospital, Newton Highland, MA, United States; Meghan Drastal, Boston Children's Hospital, Boston, MA, United States; Sidney JB. Hilker, Boston Children's Hospital, Boston, MA, United States; Mollie G. Wasserman, Boston Children's Hospital, Boston, MA, United States

Background: Escalating care for decompensating patients is a critical competency for residents. Exposure to simulation training in this area varies. We designed a needs assessment and quality improvement intervention focused on simulation to train new pediatric interns on how to call for help.

Objective: To understand intern confidence with escalating care, implement a simulation training session, and measure its perceived efficacy.

Design/Methods: During intern orientation, a needs assessment survey was created to assess prior training and current confidence levels with escalating care. Interns subsequently participated in three simulations using common clinical emergencies. Post-surveys were administered immediately after the simulations to measure confidence. A repeat needs assessment was administered four months later to assess intern confidence and perceived utility of the simulation while in practice. Results were assessed via descriptive statistics and Fisher’s Exact Tests.

Results: Initial needs assessment and post-simulation surveys were completed by 54 respondents. Most interns lacked prior training in escalating care (54%) and only 33% had previous simulation training in this area. In the needs assessment pre-survey, most interns did not feel comfortable calling an ICU consultation (57%) or urgent ICU response (56%) but reported higher comfort with calling a Code Blue (59%). There was no significant relationship between prior training experience and comfort levels. Following the simulation, participants felt significantly more comfortable when calling a non-urgent ICU consultation, urgent ICU response and Code Blue (p < 0.01). Nearly all participants felt more confident when providing a succinct patient summary to the ICU (98%) and 100% felt that the simulations solidified their ability to escalate care. Follow-up surveys four months into training were completed by 25 residents. Most residents felt comfortable calling a non-urgent ICU consultation (78%), an urgent ICU response (83%), and a Code Blue (78%) and 100% felt that the simulation solidified their ability to call for help. Most residents (91%) recommended incorporating this simulation into future orientations.

Conclusion(s): Prior training experience did not influence incoming interns’ comfort level with calling for help. Simulation experiences significantly improved comfort with recognizing when to escalate care, even several months into residency training. Simulation is effective when training residents how to escalate care. Future directions include expanding training efforts and measuring competency after simulation.

Perceived comfort with escalating to different levels of care and signing out to the ICU
Figure 1. Grouped-column bar graphs illustrate interns felt more comfortable calling a non-urgent ICU consultation (A), urgent ICU response (B), code blue (C), and signing out to ICU team (D) after performing a simulation experience. Results were analyzed using Fisher's Exact Tests. * = statistically significant.

Perceived confidence levels in escalating care four months after simulation experience, during initial months of residency.
Grouped-stacked bar graphs illustrate that the simulation experience had a lasting positive impact on participants' comfort levels, as they continued to feel more confident calling a non-urgent ICU consultation (A), urgent ICU response (B), code blue (C), and signing out to ICU team (D) even four months into residency compared to their initial pre-simulation survey responses. Results were analyzed using Fisher's Exact Tests. * = statistically significant.