10 - Pediatric Critical Care Transport Teams Performance Across a National Cohort; Multi-center, In situ, Simulation-Based Study

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 10
Publication Number: 10.107

Ranna A. Rozenfeld, Hasbro Children's Hospital/Brown University, Providence, RI, United States; Ingrid M. Anderson, Rainbow Babes & Children's Hospital, Case Western Reserve University, Cleveland Heights, OH, United States; Grace M. Arteaga, Mayo Clinic Children's Center, Rochester, MN, United States; Patricia Carreiro, Hasbro Children's Hospital at Rhode Island Hospital, Swansea, MA, United States; Stephen Gleich, Mayo Clinic, Rochester, MN, United States; Erin Hulfish, Stony Brook University Hospital, Stony Brook, NY, United States; Snimarjot Kaur, Yale School of Medicine, New Haven, CT, United States; Christopher Kennedy, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Lauren Maloney, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States; Arushi Manga, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Devin McKissic, University of Washington, Seattle, WA, United States; Erin Montgomery, Indiana University School of Medicine, Indianapolis, IN, United States; Kellie Pearson, Indiana University School of Medicine/ IU Health, Indianapolis, IN, United States; Daniel J. Scherzer, Nationwide Children's Hospital, Columbus, OH, OH, United States; Rachel Umoren, University of Washington School of Medicine, Seattle, WA, United States; Jessica Wall, Seattle Children's, Seattle, WA, United States; Robyn Wing, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Kamal Abulebda, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States

Presenting Author(s)

Ranna A. Rozenfeld, MD (she/her/hers)

Professor of Pediatrics/Division Chief Pediatric Critical Care Medicine
Brown University/Hasbro Children's Hospital
Providence, Rhode Island, United States

Background: Pediatric critical care transport (PCCT) teams are associated with improved outcomes. However, little is known about PCCT performance in acute care situations prior to or during transport.

Objective: In this simulation-based, multi-center, single-arm cohort study, we sought to characterize PCCT performance and explore the impact of transport center and team characteristics on team performance metrics.

Design/Methods:

We utilized in-situ simulation to measure and compare PCCT performance in 12 transport centers nationwide. Three simulated cases with linked assessment tools were developed by content experts. Cases and instruments were refined through a modified Delphi panel, pilot testing and revision. Raters were trained by the study PIs. Each transport team of 2-3 PCCT members participated in 3 in-situ simulations: 2 in ambulance: (a) cardiac arrest and (b) abusive head injury with increased intracranial pressure, and 1 at the sending ED: sepsis. The primary outcome was team performance, measured using a composite quality score (CQS) based on the number of actions performed correctly on the performance checklists.

Results:

A total of 74 transport teams comprising 231 members were recruited from 12 different transport centers (Table 1), 115 (49.8%) nurses, 56 (24.2%) respiratory therapists (RT), 37 (16%) paramedics and 23 (9.9%) EMT-B. All teams included nurses and 66.7% included RTs. Mean CQS for the simulated cases: cardiac 79.8% (SD 18.2), abusive head injury 87.2% (SD 17.2), sepsis 63.3% (SD 21.4) (Table 2).

Clustered mixed effects models (team performance was clustered within center) were conducted for the 3 simulations, with annual pediatric volume, patient population, center use of simulation training, and use of an RT, as covariates, with the simulated CQS as the outcome. In the unadjusted analysis there were significant differences between centers for the sepsis simulation (p = 0.004) and head injury (p = 0.03), but not between centers for the cardiac arrest simulation (p = 0.18). The mixed effects model was only significant for the sepsis simulation with higher pediatric volume (p = 0.02) and use of simulation for training (p = 0.04) predicting higher CQS scores.

Conclusion(s):

In this national cohort of PCCT teams, there is variability in performance when measured in a simulated setting. These differences are associated with volume of pediatric patients and inclusion of simulation-based training. This data can be used as benchmarking data and a guide for future initiatives to decrease variation and improve adherence to best practices for acutely ill and injured children during transport.