The Simulation-Based Assessment of Pediatric Rapid Response Teams

• Published in: The Journal of pediatrics Vol. 188; pp. 258 - 262.e1
• Main Authors: Fehr, James J., MD, McBride, Mary E., MD, Boulet, John R., PhD, Murray, David J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2017
• Subjects: Adult; Clinical Competence; Critical Care; education; Faculty, Medical; Female; Hospital Rapid Response Team; Humans; Male; Middle Aged; Missouri; Nurse Practitioners; Nursing Staff, Hospital; patient safety; Pediatrics; rapid response teams; Respiratory Therapy; simulation-based education; patient safety; NP; Postgraduate year; education; PGY; Nurse practitioner; Pediatric nurse practitioner; Intensive care unit; PICU; simulation-based education; PNP; Pediatric intensive care unit; RRT; pediatrics; rapid response teams; ICU; Rapid response team
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2017.03.030

Objective To create scenarios of simulated decompensating pediatric patients to train pediatric rapid response teams (RRTs) and to determine whether the scenario scores provide a valid assessment of RRT performance with the hypothesis that RRTs led by intensivists-in-training would be better prepared to manage the scenarios than teams led by nurse practitioners. Study design A set of 10 simulated scenarios was designed for the training and assessment of pediatric RRTs. Pediatric RRTs, comprising a pediatric intensive care unit (PICU) registered nurse and respiratory therapist, led by a PICU intensivist-in-training or a pediatric nurse practitioner, managed 7 simulated acutely decompensating patients. Two raters evaluated the scenario performances and psychometric analyses of the scenarios were performed. Results The teams readily managed scenarios such as supraventricular tachycardia and opioid overdose but had difficulty with more complicated scenarios such as aortic coarctation or head injury. The management of any particular scenario was reasonably predictive of overall team performance. The teams led by the PICU intensivists-in-training outperformed the teams led by the pediatric nurse practitioners. Conclusions Simulation provides a method for RRTs to develop decision-making skills in managing decompensating pediatric patients. The multiple scenario assessment provided a moderately reliable team score. The greater scores achieved by PICU intensivist-in-training-led teams provides some evidence to support the validity of the assessment.