Presenter Status
Resident/Psychology Intern
Abstract Type
QI
Primary Mentor
Dr. Christopher Kennedy
Start Date
11-5-2021 12:15 PM
End Date
11-5-2021 12:30 PM
Presentation Type
Oral Presentation
Description
Background/Project Intent (Aim Statement): 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. There is evidence in the adult literature that there is wide variability in the treatment of hypoglycemia3 . Currently Children’s Mercy does not have a standardized approach to the treatment of hypoglycemia not associated with diabetes mellitus. From observation in the clinical setting we believe there are gaps regarding the identification and treatment of hypoglycemia not associated with diabetes mellitus. 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.4-6
Project Aims: Our aims were to use SbCSTs combined with rapid cycle training to test system function for ED treatment of hypoglycemia.4-6 . This project focused on two questions: 1. Can SbCSTs identify gaps/LSTs and recommendations for improvement for hypoglycemia care? and 2. Would providers consider SbCSTs acceptable way to test and train?
Methods (include PDSA cycles): The study took place in a children’s hospital ED (Adele Hall and Kansas) and was approved by the IRB as nonhuman subject research. We conducted Simulation-based Clinical Systems Test (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. To collect LSTs two project staff observed, and took notes on a standardized reporting form including any gaps/LSTs identified and staff suggestions for mitigation. Provider evaluated this process with a web-based survey to evaluate the process for acceptability and utility using ratings on a 5 point Likert scale.
Results: Preliminary results: 12 SbCSTs were conducted with 22 staff 13 (59%)(7- MDs, 4-RNs, 2-APRN) filled out an evaluation. 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 Provider assessment of the process: 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.
Conclusions: This study demonstrated that simulation-based clinical systems testing (SbCST) methods are adaptable for use in a children’s hospital ED for hypoglycemia testing 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.
Additional Files
Simulation Based Clinical Systems Testing of a Pediatric ED to Im.pdf (103 kB)Abstract
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
Simulation Based Clinical Systems Testing of a Pediatric ED to Improve Staff and Process Readiness for Pediatric Hypoglycemia
Background/Project Intent (Aim Statement): 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. There is evidence in the adult literature that there is wide variability in the treatment of hypoglycemia3 . Currently Children’s Mercy does not have a standardized approach to the treatment of hypoglycemia not associated with diabetes mellitus. From observation in the clinical setting we believe there are gaps regarding the identification and treatment of hypoglycemia not associated with diabetes mellitus. 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.4-6
Project Aims: Our aims were to use SbCSTs combined with rapid cycle training to test system function for ED treatment of hypoglycemia.4-6 . This project focused on two questions: 1. Can SbCSTs identify gaps/LSTs and recommendations for improvement for hypoglycemia care? and 2. Would providers consider SbCSTs acceptable way to test and train?
Methods (include PDSA cycles): The study took place in a children’s hospital ED (Adele Hall and Kansas) and was approved by the IRB as nonhuman subject research. We conducted Simulation-based Clinical Systems Test (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. To collect LSTs two project staff observed, and took notes on a standardized reporting form including any gaps/LSTs identified and staff suggestions for mitigation. Provider evaluated this process with a web-based survey to evaluate the process for acceptability and utility using ratings on a 5 point Likert scale.
Results: Preliminary results: 12 SbCSTs were conducted with 22 staff 13 (59%)(7- MDs, 4-RNs, 2-APRN) filled out an evaluation. 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 Provider assessment of the process: 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.
Conclusions: This study demonstrated that simulation-based clinical systems testing (SbCST) methods are adaptable for use in a children’s hospital ED for hypoglycemia testing 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.
