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Background: Hypoglycemia is the most common metabolic disorder in children in pediatric emergency department (ED) settings 1. Children may present with nonspecific symptoms, or asymptomatically2. So identification/treatment is very challenging. Delayed recognition and under treatment can lead to poor patient outcomes including seizure, coma, and death. Simulation-based clinical systems tests (SbCSTs) are useful to detect gaps/latent safety threats (LSTs) in system design.3-5

Objective: Our aim was to use SbCSTs combined with rapid cycle training to test system function for ED treatment of hypoglycemia.3-5. The research questions were in 2 frames: 1. Can SbCSTs identify gaps/LSTs and recommendations for improvement and 2. Would providers consider SbCSTs acceptable way to improve?

Design/Methods: The study took place in a children’s hospital ED and was approved by the IRB as non-human subject research. We conducted SbCSTs with staff responding to a 5-month old with hypoglycemia and used “tipping-point”(s) in care to emulate challenges and a Gamaurd mannequin and a tablet-based “monitor”(SimMon). Short scripted debriefs reviewed guidelines, staff input, and then staff repeated the simulation. Participants used a survey to evaluate the SbCSTs. Two sim staff observed, and took notes on a standardized reporting form and included staff response, any gaps/LSTs identified.

Results: Preliminary results: 12 SbCSTs were conducted with 22 staff, 13 (59%)(7- MDs, 4-RNs, 2-APRN) filled out anevaluation. For question 1 LST identification: Staff identified 50 LSTs. Each LST was categorized for cause as follows:14 (28%) glucose gel location/administration concern, 12 (24%) need for a better job aid, 10 (20%) were related to dextrose dosing errors, 7 (14%) POC glucose recheck timing, and 7 (14%) inappropriate treatment. For question 2: An acceptable process: (strongly disagree, SD to strongly agree, SA): Worth the time it took: 85% SA, 15% somewhat agreed (SWA). Improved staff readiness: 85 % SA, 15% SWA. An effective way to test/provide solutions: 85% SA,15% SWA. The debrief allowed staff to share ideas: 85% SA, 15% SWA.

Conclusion(s): This study demonstrated that simulation-based clinical systems testing (SbCST) methods are adaptable for use in a children’s hospital ED for preparedness evaluation and training. Participant evaluations demonstrate a high regard for this method. The process detected many LSTs but further data analysis with a formal FMEA process will be performed.


Emergency Medicine | Pediatrics

Simulation Based Clinical Systems Testing of a Pediatric ED to Improve Staff and Process Readiness for Pediatric Hypoglycemia



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