The utilization of just-in-time simulation in optimizing the quality of rapid response calls and resident contingency planning

1. ALERT Presentation: The utilization of just-
in-time simulation in optimizing the quality
of rapid response calls and resident
contingency planning
Taylor Wheaton, MD, Kheyandra Lewis MD, Emmanuelle Topiol MD,
Sharon Calaman MD
St. Christopher’s Hospital for Children, Philadelphia, PA
INSPIRE @ IMSH 2017 – Orlando, FL, USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. • Training in the era of duty hour restrictions
– Increased handoffs
• Barriers to activation of rapid response team
– Poor self efficacy in recognizing need
– Perception of poor interpersonal implications
– Hierarchy in medical teams
• Curricula currently in the literature does not address just-in-time
simulation as it pertains to these patient-centered outcomes
International Network for Simulation-based Pediatric Innovation, Research and Education
Background

3. • Population: Pediatric residents at St. Christopher’s
• Intervention: Six months of weekly just-in-time simulation
• Control/Comparison: Six months immediately preceding the
intervention
• Outcome(s):
– Improved quality of rapid response calls
– Improve quality of contingency planning on written handoff document
International Network for Simulation-based Pediatric Innovation, Research and Education
PICO / Research Question

4. International Network for Simulation-based Pediatric Innovation, Research and Education
Approach / Design
Senior resident
identifies “watcher”
Senior resident and
simulation
coordinator develop
just-in-time simulation

5. International Network for Simulation-based Pediatric Innovation, Research and Education
Approach / Design
Inpatient team
and nursing
convene for
simulation
15 minutes of
simulation
15 minutes of
debriefing

6. International Network for Simulation-based Pediatric Innovation, Research and Education
Approach / Design
Rapid Response
Quality
Contingency plans
and Situational
Awareness
Resident
Perception
• Delayed calls >4hrs
• Disposition of the patient
• Treatments initiated on the call
• Length of stay and interventions
taken in the critical care unit if
transferred
• Quantity of plans on written
handoff document
• Quality of data on written handoff
using validated I-PASS tools
• Pre-intervention survey
• Post-intervention survey

7. • November 2015
– IRB submission
– Renewed November 2016
• February 2016
– Intervention initiated with concurrent data collection
– August 2016: Post intervention data collection started
• Ongoing data analysis for rapid responses and contingency plans
• Winter 2016-2017
• Spring 2017
International Network for Simulation-based Pediatric Innovation, Research and Education
Timeline

8. 1. Is there opportunity to expand to a multi-institutional
collaboration to increase the power of the study?
2. Are there recommendations on evaluation of trainees
and other participants?
3. Are there suggestions for reviewing additional
outcomes?
International Network for Simulation-based Pediatric Innovation, Research and Education
3 questions to improve study

9. At INSPIRE @ IMSH 2017: To obtain
multi-institutional collaboration in
expanding the study
In 2 months: To begin final phase of data
analysis
International Network for Simulation-based Pediatric Innovation, Research and Education
Goals to accomplish

10. Taylor Wheaton, Kheyandra Lewis, Emmanuelle Topiol, and
Sharon Calaman
St. Christopher’s Hospital for Children
International Network for Simulation-based Pediatric Innovation, Research and Education
Contact Information
Taylor.wheaton@drexelmed.edu
607 425 5331
Kheyandra.lewis@drexelmed.edu
215 427 4132
Emmanuelle.topiol@drexelmed.edu
215 427 5170
Sharon.calaman@drexelmed.edu
215 427 8846