Medical Emergencies in the Primary Care Setting: An Evidence Based Practice Approach Using Simulation to Improve Readiness

Monachino, AnneMarie; Caraher, Christine; Ginsberg, Julie; Bailey, Christine; White, Eliza

doi:10.1016/j.pedn.2019.09.017

Cited by 15 publications

(16 citation statements)

References 13 publications

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“…Tele-OSCE platforms have previously been described for use in formative assessment of students in rural locales as well as in assessment of basic telemedicine skills. 1,2 More recently, educators from Singapore executed a live OSCE while respecting social distancing rules due to coronavirus. 3 Our teleOSCE is unique in its use of an entirely virtual platform for a high-stakes summative assessment of clinical skills, while still maintaining locally established SP checklists, communication scoring tools, and faculty observation rubrics.…”

mentioning

confidence: 99%

Remote Assessment of Clinical Skills During COVID-19: A Virtual, High-Stakes, Summative Pediatric Objective Structured Clinical Examination

Lara

Foster

Hawks

et al. 2020

Academic Pediatrics

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In April 2020, we launched virtual interprofessional small group mock codes. Using a video conferencing platform, we brought together »5 staff and 1 facilitator. Roles included: medical assistants, registered nurses, physicians, nurse practitioners, and phlebotomists. Materials were emailed to staff to review prior to the session. The facilitator hosted the online meeting from the office. During each 35-minute session, the team collaborated via video conference to manage a common pediatric emergency: a seizure. The staff virtually "assessed" the child, reviewed emergency protocols, and assigned team roles. The facilitator coached the group to describe locations of supplies in the code cart and office. When directed by team members, the facilitator demonstrated how to use appropriate equipment and treatments. Each session concluded with a short debrief to reflect on strengths as well as learning gaps.

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mentioning

confidence: 99%

Remote Assessment of Clinical Skills During COVID-19: A Virtual, High-Stakes, Summative Pediatric Objective Structured Clinical Examination

Lara

Foster

Hawks

et al. 2020

Academic Pediatrics

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“…Regularly recurring, short, locally run training sessions dedicated to locating and using emergency equipment may address this issue. In-situ simulation of medical crises in the primary care setting has been shown to increase the self-reported confidence and competence of personnel [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Impediments to and impact of checklists on performance of emergency interventions in primary care: an in situ simulation-based randomized controlled trial

Dryver

Knutsson²,

Ekelund

et al. 2021

Scandinavian Journal of Primary Health Care

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Objective: Medical crises occur rather seldom in the primary care setting, but when they do, initial management impacts on morbidity and mortality. Factors that impede the performance of emergency interventions in primary care have not been studied through in-situ simulation. Checklists reportedly improve crisis management. Design: This randomized controlled trial evaluated emergency intervention performance during two scenarios (hypoglycemia-coma and anaphylaxis-cardiac arrest) simulated at primary care centers, and whether checklist access improved performance. Setting: Twenty-two primary care centers in Southern Sweden participated in the study. Subjects: A total of 347 personnel performed 100 simulations, 45 with and 55 without checklist access. Main outcome measures: Time and impediments to performance of five emergency interventions in each scenario. Results: On 28 of the 37 occasions when the adrenalin auto-injector was employed, the administration technique was incorrect. In 9 of 49 scenarios, teams had trouble locating the 30% glucose solution. Median time to supplemental oxygen administration during the first scenario was 186 s compared with 96 s during the second scenario (p < 0.001). Checklist access had no significant impact on time to performance of emergency interventions, aside from shorter time to adequate glucose or glucagon administration (median times 632 s with, 756 s without checklist access; p ¼ 0.03). Conclusion: Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting. Simply providing checklist access does not improve the performance of emergency interventions. KEY POINTSLittle is known about the factors that affect the performance of emergency interventions in the primary care setting. Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting. Simply providing crisis checklist access does not improve the performance of emergency interventions in the primary care setting.

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“…offices to manage common medical emergencies requires routine training of staff. 1 The American Academy of Pediatrics 2 recommends simulated exercises, or mock codes, for staff to practice the steps of an emergency. Our large urban pediatric primary care office sees >300 patients daily and provides care to the largest number of medically complex patients in our network of 31 practices.…”

Section: T a G G E D H 1 Outcomes To Datet A G G E D E N Dmentioning

confidence: 99%

“…In particular, it is clear that smaller group trainings improve participation by all team members. 1 Therefore, after COVID-19, we will adapt our mock codes by using small group online sessions to supplement our annual in-person trainings. We also plan to strengthen these virtual learning experiences by incorporating tools that augment simulated reality, such as pairing the case with a "patient" video or using a simulation manikin.…”

Section: T a G G E D H 1 Outcomes To Datet A G G E D E N Dmentioning

confidence: 99%

Primary Care Mock Codes During a Pandemic: Interprofessional Team-Based Emergency Education While Maintaining Social Distance

Huang

Pulice

Sullivan

2020

Academic Pediatrics

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preparation for the "classroom" session. The classroom session focuses on case-based knowledge application rather than knowledge acquisition."Megaflip" sessions are delivered via the Zoom (San Jose, Calif) platform. A small group of facilitators (2−3) hosts the Megaflip and interested programs request a link to participate. The participating programs provide a local facilitator to lead their own fellows in large group and breakout discussions. This facet of "Megaflip" allows the faculty team to highlight important interinstitutional practice differences and expands the peer-learning opportunity across programs. The Zoom platform overcomes many of the challenges of a large group interactive session by allowing learners to virtually raise their hand, answer yes/ no questions with the click of a button, utilize the chat feature, and participate in smaller group discussions via the breakout room feature.

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Medical Emergencies in the Primary Care Setting: An Evidence Based Practice Approach Using Simulation to Improve Readiness

Cited by 15 publications

References 13 publications

Remote Assessment of Clinical Skills During COVID-19: A Virtual, High-Stakes, Summative Pediatric Objective Structured Clinical Examination

Remote Assessment of Clinical Skills During COVID-19: A Virtual, High-Stakes, Summative Pediatric Objective Structured Clinical Examination

Impediments to and impact of checklists on performance of emergency interventions in primary care: an in situ simulation-based randomized controlled trial

Primary Care Mock Codes During a Pandemic: Interprofessional Team-Based Emergency Education While Maintaining Social Distance

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