Treatment of status epilepticus in pediatrics: curriculum learning combined with in-situ simulations

Abstract

Background Appropriate and timely treatment of status epilepticus (SE) reduces morbidity and mortality. Therefore, skill-based identification and management are critical for emergency physicians. Purpose To assess whether the ability of training physicians, residents, nurses, and others to respond to SE as a team could be improved by using curriculum learning [Strategies and Tools to Enhance Performance and Patient Safety of Team (TeamSTEPPS) course training] combined with in-situ simulations of emergency department (ED) staff. Approach A pre-training-post-training design was used on SE skills and teamwork skills. Emergency training, residents, and N1 and N2 nurses completed the SE skill and teamwork assessments (pre-training) through in-situ simulation. Next, the participating physicians and nurses attended the SE course [Strategies and Tools to Enhance Performance and Patient Safety of Team (TeamSTEPPS) course training], followed by conscious skill practice, including in-situ simulation drills every 20 days (eight times total) and deliberate practice in the simulator. The participants completed the SE skill and teamwork assessments (post-training) again in an in-situ simulation. Pre-training-post-training simulated SE skills and teamwork performance were assessed. The simulation training evaluation showed that the training process was reasonable, and the training medical staff had different degrees of benefit in increasing subject interest, improving operational skills, theoretical knowledge, and work self-confidence. Findings Sixty doctors and nurses participated in the intervention. When comparing the SE skills of 10 regular training physicians pre-training and post-training, their performance improved from 40% (interquartile range (IQR): 0–1) before training to 100% (IQR: 80.00–100) after training (p < 0.001). The teamwork ability of the 10 teams improved from 2.43 ± 0.09 before training to 3.16 ± 0.08 after training (p < 0.001). Conclusion SE curriculum learning combined with in-situ simulation training provides the learners with SE identification and management knowledge in children and teamwork skills.

Assessing Outcome Measurements and Impact of Simulation in Neurocritical Care Training: A Systematic Review

“…Their presimulation assessment for technical knowledge consisted of 4 questions that were answered by either “yes” or “no.” Postsimulation assessment was performed using a checklist that was specific to the simulation scenario. Wei et al 16 used a 26-item checklist to assess clinical performance of status epilepticus management. Hocker et al 13 used a questionnaire that was sent to the participants 1 week before and 1 week after simulation to assess their knowledge.…”

“…The JBI quasi-experimental critical appraisal tool was used for the remaining 8 studies. [11][12][13][14][15][16][17][18] The overall quality of the relevant studies was moderate to high, with a range of 61.1% to 77.8%. We did not exclude any study because of methodological quality issues.…”

“…Of the 9 studies included in this review, 1 study was a quality improvement project, 19 whereas 8 studies used a quasi-experimental design (see Supplemental Digital Content 1, http://links.lww.com/ JNN/A522). [11][12][13][14][15][16][17][18] Most of the studies were from the United States, 11,[13][14][15]17,18 1 study was from China, 16 and 2 studies were from the United Kingdom. 12,19 The total sample size in the eligible studies was 286, with a range of 9 to 60 participants.…”

“…Most of the studies included physicians only, 11,13,14,17,18 and 1 study recruited nurses only, 15 whereas others recruited a combination of physicians, nurses, and physician assistants. 12,16,19 We were able to identify 3 outcome measurements for simulation in neurocritical care: knowledge and clinical performance; confidence and comfort; and teamwork, communication, and leadership skills. We chose to report our findings narratively under each one of these outcome categories.…”

“…Only 1 study addressed the validity and reliability of the tool used. 16 Importantly, the International Nursing Association for Clinical Simulation and Learning recommends using reliable and valid tools to evaluate the simulation experience. 21 This optimizes the rigor of the studies and allows for better synthesis for the evidence.…”