2.50
Hdl Handle:
http://hdl.handle.net/10755/306570
Category:
Abstract
Type:
Poster
Title:
Simulation to Design and Implement a Critical Airway Team
Author(s):
Oehler, Jennifer; Kerrey, Benjamin; Bauer, Jerome; Johnson, Kaalan
Lead Author STTI Affiliation:
Non-member
Author Details:
Jennifer Oehler, BSN, RN, Jennifer.Oehler@cchmc.org; Benjamin Kerrey, MD, MS; Jerome Bauer, RN; Kaalan Johnson, MD
Abstract:

Research Abstract

Purpose: Critical airway obstruction in children is a high-acuity, low frequency emergency. In an emergency department (ED), children with critical airway obstruction often require a multidisciplinary approach, including practitioners from Otolaryngology (ENT) and Anesthesiology, operating room (OR) staff, and specialized equipment. The objective of this project was to improve the quality of care for children with critical airway obstruction in the ED.

Design: A prospective project using simulation in the care environment both to assess an existing system of care and to design and implement a novel system.

Setting: ED and OR at a large, tertiary care pediatric hospital.

Participants/Subjects: Participants were ED staff, including physicians, nurses, respiratory therapists, paramedics, patient-care assistants, anesthesia, ENT physicians, OR staff, and respiratory therapists from an airway unit.

Methods: A novel in situ simulation scenario of a four-year-old with respiratory distress from a foreign body aspiration was developed. Six simulations were conducted to assess the existing system of care. Using insights gained from these simulations, a unique system of care was designed. Education and training for the new system was provided to ED staff, anesthesia, OR staff, ENT, and respiratory therapists using a new airway cart. Six simulations were then conducted to test the novel system prior to implementation in March 2012. Data was collected by the study investigators through direct observation on a standardized form. All simulations were video recorded and video review was used to confirm the data collected by direct observation. Data collected included arrival times of subspecialists, equipment availability, airway procedures performed, latent safety threats (LSTs) in the existing system, and care provider knowledge deficits (KDs).

Results/Outcomes: There were 196 providers who participated in the 12 simulations. From ED physician request to the arrival of an ENT provider, mean time was 7.8 minutes in the existing system simulations and 5 minutes for the novel system simulations. Anesthesia response times were similar in both sets of simulations. Airway equipment took greater than 10 minutes to arrive for two of the existing system simulations. In the novel system simulations, a specialized airway cart was available by design and arrived an average of 3.9 minutes after requested. Death of the simulated patient occurred in 2 existing system simulations; specialized airway equipment was available for neither. No deaths occurred and airway equipment was available for all 6 novel system simulations. Thirteen LSTs and 11 KDs were identified in the 12 simulations and addressed in the novel system.

Implications: Simulation was a safe, effective method to assess a system of care for high-acuity, low frequency patients in a pediatric ED. For simulated patients, a novel system of care for patients with critical airway obstruction enabled multiple health care providers to respond more rapidly and in a coordinated fashion. Multiple latent, systemic threats to patient safety were identified using simulation and addressed by the novel system of care. Since implementation in March 2012, the system has been used for 12 patients in the ED and was expanded to the pediatric intensive care unit in October 2012.

Keywords:
Critical Airway Obstruction in Children
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleSimulation to Design and Implement a Critical Airway Teamen_GB
dc.contributor.authorOehler, Jenniferen_GB
dc.contributor.authorKerrey, Benjaminen_GB
dc.contributor.authorBauer, Jeromeen_GB
dc.contributor.authorJohnson, Kaalanen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsJennifer Oehler, BSN, RN, Jennifer.Oehler@cchmc.org; Benjamin Kerrey, MD, MS; Jerome Bauer, RN; Kaalan Johnson, MDen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306570-
dc.description.abstract<p>Research Abstract</p><p>Purpose: Critical airway obstruction in children is a high-acuity, low frequency emergency. In an emergency department (ED), children with critical airway obstruction often require a multidisciplinary approach, including practitioners from Otolaryngology (ENT) and Anesthesiology, operating room (OR) staff, and specialized equipment. The objective of this project was to improve the quality of care for children with critical airway obstruction in the ED.</p><p>Design: A prospective project using simulation in the care environment both to assess an existing system of care and to design and implement a novel system.</p><p>Setting: ED and OR at a large, tertiary care pediatric hospital.</p><p>Participants/Subjects: Participants were ED staff, including physicians, nurses, respiratory therapists, paramedics, patient-care assistants, anesthesia, ENT physicians, OR staff, and respiratory therapists from an airway unit.</p><p>Methods: A novel in situ simulation scenario of a four-year-old with respiratory distress from a foreign body aspiration was developed. Six simulations were conducted to assess the existing system of care. Using insights gained from these simulations, a unique system of care was designed. Education and training for the new system was provided to ED staff, anesthesia, OR staff, ENT, and respiratory therapists using a new airway cart. Six simulations were then conducted to test the novel system prior to implementation in March 2012. Data was collected by the study investigators through direct observation on a standardized form. All simulations were video recorded and video review was used to confirm the data collected by direct observation. Data collected included arrival times of subspecialists, equipment availability, airway procedures performed, latent safety threats (LSTs) in the existing system, and care provider knowledge deficits (KDs).</p><p>Results/Outcomes: There were 196 providers who participated in the 12 simulations. From ED physician request to the arrival of an ENT provider, mean time was 7.8 minutes in the existing system simulations and 5 minutes for the novel system simulations. Anesthesia response times were similar in both sets of simulations. Airway equipment took greater than 10 minutes to arrive for two of the existing system simulations. In the novel system simulations, a specialized airway cart was available by design and arrived an average of 3.9 minutes after requested. Death of the simulated patient occurred in 2 existing system simulations; specialized airway equipment was available for neither. No deaths occurred and airway equipment was available for all 6 novel system simulations. Thirteen LSTs and 11 KDs were identified in the 12 simulations and addressed in the novel system.</p><p>Implications: Simulation was a safe, effective method to assess a system of care for high-acuity, low frequency patients in a pediatric ED. For simulated patients, a novel system of care for patients with critical airway obstruction enabled multiple health care providers to respond more rapidly and in a coordinated fashion. Multiple latent, systemic threats to patient safety were identified using simulation and addressed by the novel system of care. Since implementation in March 2012, the system has been used for 12 patients in the ED and was expanded to the pediatric intensive care unit in October 2012.</p>en_GB
dc.subjectCritical Airway Obstruction in Childrenen_GB
dc.date.available2013-12-09T16:59:59Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T16:59:59Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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