ACEP SimBox: A Pediatric Simulation-Based Training Innovation

Vora, Samreen; Li, Joyce; Kou, Maybelle; Ng, Vivienne; Price, Amanda; Claudius, Ilene; Kant, Shruti; Sanseau, Elizabeth; Madhok, Manu; Auerbach, Marc

doi:10.1016/j.annemergmed.2021.03.040

Cited by 10 publications

(10 citation statements)

References 20 publications

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“…Simulation‐based interventions have been associated with improved pediatric readiness, clinical care processes, and clinical outcomes 13,14 . Many effective simulation programs involve pediatric emergency medicine specialty–trained physicians and education content experts at academic medical centers (AMCs) collaborating with CEDs to develop evidence‐based training methods for up‐to‐date clinical content 15–18 . Multiple models of AMCs conducting simulation‐based interventions in CEDs have been adopted 5,11 .…”

Section: Introductionmentioning

confidence: 99%

“…13,14 Many effective simulation programs involve pediatric emergency medicine specialty-trained physicians and education content experts at academic medical centers (AMCs) collaborating with CEDs to develop evidence-based training methods for up-to-date clinical content. [15][16][17][18] Multiple models of AMCs conducting simulation-based interventions in CEDs have been adopted. 5,11 However, the requirement of academic teams to travel to community hospitals for pediatric training has limited scalability and sustainability due to required time and financial commitments.…”

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confidence: 99%

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Blueprint for community emergency department pediatric simulation

Kaur,

Lynders,

Goldman

et al. 2023

AEM Education and Training

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BackgroundGaps in quality of pediatric emergency care have been noted in community emergency departments (CEDs), where >85% of children receive care. In situ simulation provides opportunities for hands‐on experiences and can help close these gaps. We aimed to develop, implement, and evaluate an innovative, replicable, and scalable pediatric in situ simulation‐based CED curriculum, under the leadership of a local colleague, through collaborative approach with a regional academic medical center (AMC).MethodsKern's model was used as follows: problem identification and general needs assessment—pediatric readiness assessment and discussions with CED physician and nursing leadership; targeted needs assessment—review of recent pediatric transfer cases; goals and objectives—enhance pediatric knowledge and skills of interprofessional teams and detect latent safety threats; educational strategies—codeveloped by CED and AMC, included prelearning using podcasts and videos, simulation and facilitated debriefing, resource sharing after simulations; implementation—3‐h simulation sessions facilitated in person by the CED team and remotely by AMC (leadership required participation and paid staff); and evaluation and feedback—retrospective pre–post survey, Simulation Effectiveness Tool–Modified (SET‐M), Net Promoter Score (NPS), and review/feedback meetings.ResultsBased on needs assessment, the selected cases included newborn resuscitation, seizure, asthma, and tetrahydrocannabinol ingestion causing altered mental sensorium in a child. Twenty‐four 3‐h simulation sessions were conducted over 1 year. A total of 168 participants completed the sessions, while 75 participants (54.7% nurses, 22.7% physicians, and others) completed feedback surveys. Seventy‐six percent of participants reported completing presimulation education material. Participants reported improved skills at appropriately evaluating a critically ill newborn and critically ill infant/toddler and improved teamwork during the care of a pediatric patient. The majority agreed that simulation was effective in teaching pediatric resuscitation. The NPS was 84% (excellent).ConclusionsA locally facilitated CED in situ simulation curriculum was successfully developed and implemented under local leadership, with remote collaboration by AMC. The curriculum was well received and effective.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Blueprint for community emergency department pediatric simulation

Kaur,

Lynders,

Goldman

et al. 2023

AEM Education and Training

Self Cite

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“…This model has shown efficacy 3,7,10–12 ; however, these simulations do not present real‐world clinical challenges of taking care of multiple patients simultaneously while on shift. Another ISS model included distributing simulation kits and video links to train community health care professionals 13 . Our innovation created a mobile, train‐the‐trainer model, enabling general EDs to implement ISS without direct facilitation by academic simulation faculty.…”

Section: Introductionmentioning

confidence: 99%

“…Another ISS model included distributing simulation kits and video links to train community health care professionals. 13 Our innovation created a mobile, train-the-trainer model, enabling general EDs to implement ISS without direct facilitation by academic simulation faculty.…”

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confidence: 99%

Implementation of a pediatric in situ, train‐the‐trainer simulation program in general emergency departments

Schertzer

Wang

Khanna

et al. 2023

AEM Education and Training

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Background Most children receive emergency care in general emergency departments (EDs). Pediatric resuscitations require specific equipment and weight‐based dosing that may be less familiar to general ED healthcare professionals. In situ simulation (ISS) improves teamwork and problem solving, and it may identify latent safety threats. This innovative program brought academic faculty to participating hospitals and taught simulation principles in a small‐group environment. This format removed many of the barriers to implementing simulations for general EDs and was intended to teach principles for utilizing simulation to meet unique departmental needs. Methods Using the Consolidated Framework for Implementation Research (CFIR) framework, ED teams at eight hospitals participated in a train‐the‐trainer program from 2016 to 2020 intended to help them implement their own ISSs. Training covered benefits of ISS, use of simulation for identifying latent safety threats, debriefing principles, and potential safety risks of ISS. Faculty also provided on‐site mentoring during the implementation phase. We identified factors and barriers that contributed to the successful adoption of an ISS program. Results Most hospitals continued their ISS program after the study ended. Several themes emerged as pearls and pitfalls to implementing a train‐the‐trainer program. Successful teams had strong nursing and physician leadership participation, and team members had positive working relationships with early positive feedback which encouraged future ISS implementation. Barriers to simulation included high staff turnover of nurses and physicians as well as social distancing protocols related to infection control. Conclusions Academic EDs can partner with general EDs to implement a train‐the‐trainer simulation program. We describe facilitators and barriers to implementing a train‐the‐trainer ISS program in general EDs to improve emergency care for high‐risk, low‐frequency events.

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“…Facilitation and assessment can be performed either synchronously or asynchronously using video conferencing tools (8)(9)(10)(11)(12)(13)(14)(15)(16). The concept of telesimulation using prerecorded video was adapted from the ACEP SimBox, a free and openly accessible web-based simulation platform demonstrated to be easy to use, feasible, and recommended by healthcare team users (17)(18)(19)(20)(21). While the SimBox utilizes a single-track video that can be paused, rewound, or fast-forward, Annenberg hotkeys provides a random-access interface that allows a facilitator to play prerecorded videos in any order at any time, permitting a video narrative to be created on-the-fly based on input from users.…”

Section: Introductionmentioning

confidence: 99%

Low-Cost “Telesimulation” Training Improves Real Patient Pediatric Shock Outcomes in India

et al. 2022

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IntroductionPediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcome. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COVID-19 pandemic restrictions on in-person simulation led us to the development of telesimulation for shock. We hypothesized that telesimulation training would improve pediatric shock recognition, process of care, and patient outcomes in both simulated and real patient settings.Materials and MethodsWe conducted a prospective quasi-experimental interrupted time series cohort study over 9 months. We conducted 40 telesimulation sessions for 76 participants in teams of 3 or 4, utilizing the video telecommunication platform (Zoom©). Trained observers recorded time-critical interventions on real patients for the pediatric emergency teams composed of residents, fellows, and nurses. Data were collected on 332 pediatric patients in shock (72% of whom were in septic shock) before, during, and after the intervention. The data included the first hour time-critical intervention checklist, patient hemodynamic status at the end of the first hour, time for the resolution of shock, and team leadership skills in the emergency room.ResultsThere was a significant improvement in the percent completion of tasks by the pediatric emergency team in simulated scenarios (69% in scenario 1 vs. 93% in scenario 2; p < 0.001). In real patients, completion of tasks as per time-critical steps reached 100% during and after intervention compared to the pre-intervention phase (87.5%), p < 0.05. There was a significant improvement in the first hour hemodynamic parameters of shock patients: pre (71%), during (79%), and post (87%) intervention (p < 0.007 pre vs. post). Shock reversal time reduced from 24 h pre-intervention to 6 h intervention and to 4.5 h post intervention (p < 0.002). There was also a significant improvement in leadership performance assessed by modified Concise Assessment of Leader Management (CALM) instrument during the simulated (p < 0.001) and real patient care in post intervention (p < 0.05).ConclusionTelesimulation training is feasible and improved the process of care, time-critical interventions, leadership in both simulated and real patients and resolution of shock in real patients. To the best of our knowledge, this is one of the first studies where telesimulation has shown improvement in real patient outcomes.

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ACEP SimBox: A Pediatric Simulation-Based Training Innovation

Cited by 10 publications

References 20 publications

Blueprint for community emergency department pediatric simulation

Blueprint for community emergency department pediatric simulation

Implementation of a pediatric in situ, train‐the‐trainer simulation program in general emergency departments

Low-Cost “Telesimulation” Training Improves Real Patient Pediatric Shock Outcomes in India

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