Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Chris Kennedy
Start Date
14-5-2024 11:30 AM
End Date
14-5-2024 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Emergent presentations are a relatively uncommon occurrence in the ambulatory care setting. However, when they do occur, they can be life threatening. Given their uncommon occurrence, many clinicians believe that emergencies do not present or do not occur in these settings. However, there can be up to 42 emergent presentations per office site per year, depending on location. Most commonly pediatric patients present with respiratory distress, but seizures, anaphylaxis, dehydration, and psychological/behavioral complaints can also present emergently to these clinics. Despite this, most offices are not prepared to handle these presentations. According to various studies, this is typically due to a lack of equipment, protocols, provider resuscitation skills, awareness of possible emergencies or a reliance on EMS to help the patient. There have been a few studies utilizing traditional simulation as a tool for pediatric outpatient emergency preparedness that showed subjective improvement in office preparedness. To our knowledge, there have been no studies utilizing rapid cycle deliberate practice simulation (RCDP) as a tool for education or preparedness in these settings or to assess for overall preparedness of the system for these patients.
Objectives/Goal: This study will assess for the perceived preparedness and knowledge gaps of ambulatory pediatric providers, specifically addressing the initial management of the acutely decompensating pediatric patient. Secondarily, we hope to identify latent safety threats (LSTs) that may affect preparedness in these settings by combining simulation based clinical system testing (SbCST) with RCDP concepts.
Methods/Design: A cross sectional survey of general pediatric providers, family medicine providers, and urgent care providers is being conducted in Kansas and Missouri. This is an electronic survey consisting of 31 questions regarding perceived preparedness and knowledge gaps of providers in these settings. Descriptive statistics will be used to analyze results between the groups. Outpatient practices are also being recruited to participate in SbCST. These clinics will participate in a RCDP simulation on respiratory distress and an observational form will be utilized by simulation staff to note any LSTs observed. LSTs and solutions to these threats will be sought from staff during the debriefing period. A post simulation survey will be conducted for feasibility and utility. Qualitative data will be analyzed via an inductive thematic approach.
Results: Data is still being collected, however, our preliminary data shows most providers are physicians, working in general pediatric offices with 10+ years of experience. They frequently transfer patients to the hospital/emergency department after providing in office treatment, most commonly related to respiratory distress. Most described themselves as proficient in managing respiratory distress and the skills related to managing respiratory distress/failure. Most rated themselves as competent or advanced beginner in other management skills and emergent presentations. For SbCST, themes include medication, equipment use, and staff knowledge.
Conclusions: Pending final results. Preliminary data suggests that respiratory distress is the most common emergent presentation seen in our general pediatrics clinics, as previous described in the literature. Most feel comfortable taking care of these patient presentations and feel uncomfortable/less prepared to manage other presentations.
Pediatric Readiness in the Ambulatory Care Setting
Background: Emergent presentations are a relatively uncommon occurrence in the ambulatory care setting. However, when they do occur, they can be life threatening. Given their uncommon occurrence, many clinicians believe that emergencies do not present or do not occur in these settings. However, there can be up to 42 emergent presentations per office site per year, depending on location. Most commonly pediatric patients present with respiratory distress, but seizures, anaphylaxis, dehydration, and psychological/behavioral complaints can also present emergently to these clinics. Despite this, most offices are not prepared to handle these presentations. According to various studies, this is typically due to a lack of equipment, protocols, provider resuscitation skills, awareness of possible emergencies or a reliance on EMS to help the patient. There have been a few studies utilizing traditional simulation as a tool for pediatric outpatient emergency preparedness that showed subjective improvement in office preparedness. To our knowledge, there have been no studies utilizing rapid cycle deliberate practice simulation (RCDP) as a tool for education or preparedness in these settings or to assess for overall preparedness of the system for these patients.
Objectives/Goal: This study will assess for the perceived preparedness and knowledge gaps of ambulatory pediatric providers, specifically addressing the initial management of the acutely decompensating pediatric patient. Secondarily, we hope to identify latent safety threats (LSTs) that may affect preparedness in these settings by combining simulation based clinical system testing (SbCST) with RCDP concepts.
Methods/Design: A cross sectional survey of general pediatric providers, family medicine providers, and urgent care providers is being conducted in Kansas and Missouri. This is an electronic survey consisting of 31 questions regarding perceived preparedness and knowledge gaps of providers in these settings. Descriptive statistics will be used to analyze results between the groups. Outpatient practices are also being recruited to participate in SbCST. These clinics will participate in a RCDP simulation on respiratory distress and an observational form will be utilized by simulation staff to note any LSTs observed. LSTs and solutions to these threats will be sought from staff during the debriefing period. A post simulation survey will be conducted for feasibility and utility. Qualitative data will be analyzed via an inductive thematic approach.
Results: Data is still being collected, however, our preliminary data shows most providers are physicians, working in general pediatric offices with 10+ years of experience. They frequently transfer patients to the hospital/emergency department after providing in office treatment, most commonly related to respiratory distress. Most described themselves as proficient in managing respiratory distress and the skills related to managing respiratory distress/failure. Most rated themselves as competent or advanced beginner in other management skills and emergent presentations. For SbCST, themes include medication, equipment use, and staff knowledge.
Conclusions: Pending final results. Preliminary data suggests that respiratory distress is the most common emergent presentation seen in our general pediatrics clinics, as previous described in the literature. Most feel comfortable taking care of these patient presentations and feel uncomfortable/less prepared to manage other presentations.
