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Liu CH, Yang CW, Lockey A, Greif R, Cheng A, Education, Implementation, Team Task Force of the International Liaison Committee on Resuscitation ILCOR. Factors influencing workload and stress during resuscitation - A scoping review. Resusc Plus 2024; 18:100630. [PMID: 39790340 PMCID: PMC11711810 DOI: 10.1016/j.resplu.2024.100630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 01/12/2025] Open
Abstract
Aim This scoping review aimed to identify potential variables influencing healthcare provider's perceived workload or stress when performing resuscitation on patients in cardiac arrest. Methods We searched Medline, EMBASE, PsycINFO, Cochrane, and Allied Health Literature (CINAHL) to identify studies published prior to February 1, 2024. We used a PECO format for this review: the population were healthcare providers performing resuscitation during simulated or real cardiac arrest; the exposure was the presence of any factor that could impact perceived workload or stress; and the comparator was the absence of any specific factor. Outcome variables, including self-reported questionnaires, objective and subjective measures, and any variables identified to have impact on workload and/or stress were extracted. Results Of the initially identified 10,165 studies, 24 studies (20 RCTs, 2 quasi-experimental studies and 2 observational studies) were ultimately included. Among them, a wide variety of factors influencing perceived stress or workload were identified. High heterogeneity among studies was observed. We categorized factors into the following entities: (1) team composition and roles; (2) telemedicine; (3) workflow; (4) tools; (5) cognitive aids; (6) presence of friends and family, and (7) provider experience and exposure, representing the modifiable factors for future interventions. Conclusion This scoping review provides an overview of factors influencing workload and stress during real and simulated cardiac arrest resuscitation. These findings highlight the need for targeted strategies to effectively manage workload and stress during resuscitation.
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Affiliation(s)
- Cheng-Heng Liu
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Wei Yang
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Andrew Lockey
- Emergency Department, Calderdale & Huddersfield NHS Trust, Halifax, UK
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Adam Cheng
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Alberta, Canada
| | - Education, Implementation, Team Task Force of the International Liaison Committee on Resuscitation ILCOR
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
- Emergency Department, Calderdale & Huddersfield NHS Trust, Halifax, UK
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Alberta, Canada
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2
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Ivankovic J, Bahr N, Meckler GD, Hansen M, Eriksson C, Guise JM. Identifying high cognitive load activities during simulated pediatric cardiac arrest using functional near-infrared spectroscopy. Resusc Plus 2023; 14:100409. [PMID: 37424768 PMCID: PMC10323221 DOI: 10.1016/j.resplu.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Aim To identify specific activities associated with high cognitive load during simulated pediatric out-of-hospital cardiac arrest (POHCA) resuscitation using physiological monitoring with functional near-infrared spectroscopy (fNIRS). Methods We recruited teams of emergency medical services (EMS) responders from fire departments located throughout the Portland, OR metropolitan area to participate in POHCA simulations. Teams consisted of both paramedics and emergency medical technicians (EMTs), with one paramedic serving as the person in charge (PIC). The PIC was outfitted with the OctaMon to collect fNIRS signals from the prefrontal cortex. Signals reported changes in oxygenated and deoxygenated hemoglobin concentrations, which were used to determine moments of increased cognitive activity. Increased cognitive activity was determined by significant increases in oxygenated hemoglobin and decreases in deoxygenated hemoglobin. Significant changes in fNIRS signals were associated with specific concurrent clinical tasks recorded by two independent researchers using video review. Results We recorded cognitive activity of EMS providers in 18 POHCA simulations. We found that a proportion of PIC's experienced relatively high cognitive load during medication administration, defibrillation, and rhythm checks compared to other events. Conclusion EMS providers commonly experienced increased cognitive activity during key resuscitation tasks that were related to safely coordinating team members around calculating and administering medications, defibrillation, and rhythm and pulse checks. Understanding more about activities that require high cognitive demand can inform future interventions that reduce cognitive load.
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Affiliation(s)
- Jonathan Ivankovic
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA
| | - Nathan Bahr
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA
| | - Garth D Meckler
- Departments of Pediatrics and Emergency Medicine, University of British Columbia, 24-1160 Nicola Street, Vancouver, BC V6G 2E5, Canada
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, HRC 11D01, Portland, OR 97239, USA
| | - Carl Eriksson
- Department of Pediatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, CDRC 1231, Portland, OR 97239, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, East campus- Kirstein 3rd floor- OBGYN, 330 Brookline Ave, Boston, MA 02215, USA
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Zehnder EC, Law BHY, Schmölzer GM. Assessment of Healthcare Provider Workload in Neonatal Resuscitation. Front Pediatr 2020; 8:598475. [PMID: 33415089 PMCID: PMC7784715 DOI: 10.3389/fped.2020.598475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022] Open
Abstract
Objective: Human errors or protocol deviations during neonatal resuscitation are common. Excess workload has been proposed as a contributor to human error during medical tasks. We aim to characterize healthcare providers' perceived workload during neonatal resuscitation. Design: Perceived workload was measured using a multi-dimensional retrospective National Aeronautics and Space Administration Task Load Index (NASA TLX) survey. The NASA TLX collects data on mental, physical, and temporal demand, performance, effort, and frustration. Each section is rated independently by participants on a scale of 0-20 (0 being lowest and 20 being highest). The Raw-TLX score is a composite score of all dimensions and presented on a scale of 0-100. Healthcare providers complete a paper and pencil survey after attending delivery room resuscitations within 3 months. Setting: Level three neonatal intensive care unit at the Royal Alexandra Hospital, Edmonton, AB, Canada. Participants: All neonatal healthcare providers who attended deliveries. Exposure: Participation in the delivery room care of newborns. Measurement: Raw TLX scores as a measure of overall workload and scores for each dimension of workload. Main Results: During the study period, ~880 neonatal resuscitation events occurred, and a total of 204 surveys were completed. Healthcare providers completed one survey for 179 deliveries, two surveys for 20 deliveries, and three surveys for 5 deliveries. The mean (standard deviation) gestational age was 35 (5) weeks, and the median (interquartile range) birth weight was 2,690 (1,830-3,440) g. Interventions at delivery were (i) stimulation 149 (73%), suction 130 (64%), continuous positive airway pressure 120 (59%), positive pressure ventilation 105 (52%), intubation 33 (16%), chest compression 10 (5%), and epinephrine 4 (2%). The overall median (interquartile range) Raw-TLX was 34 (18-49). The scores varied by dimension with mental demand 10 (5-14), physical demand 4 (1-6), temporal demand 8 (3-14), performance 4 (2-6), effort 8 (4-13), and frustration 4 (1-10). Raw-TLX scores were higher when healthcare providers performed any intervention compared to no intervention [35 (22-49) vs. 8 (6-18), p = 0.0011]; intubation and no intubation was [55 (46-62) vs. 30 (17-46), p = 0.0001], and between performing chest compression vs. no chest compression [55 (49-64) vs. 33 (18-47), p = 0.001]. Conclusion: Perceived workload of neonatal healthcare providers increases during higher acuity deliveries. Healthcare providers' workload during neonatal resuscitation can be measured using NASATLX and was inversely associated with 5-min Apgar score. Future studies assessing healthcare providers' perceived workload during neonatal resuscitation in different settings are warranted.
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Affiliation(s)
- Emily C. Zehnder
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Brenda H. Y. Law
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Georg M. Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Young AL, Doughty CB, Williamson KC, Won SK, Rus MC, Villarreal NN, Camp EA, Lemke DS. Workload of learners during simulated paediatric cardiopulmonary resuscitation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:338-344. [PMID: 35515742 PMCID: PMC8936742 DOI: 10.1136/bmjstel-2020-000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/03/2022]
Abstract
IntroductionLearner workload during simulated team-based resuscitations is not well understood. In this descriptive study, we measured the workload of learners in different team roles during simulated paediatric cardiopulmonary resuscitation.MethodsPaediatric emergency nurses and paediatric and emergency medicine residents formed teams of four to eight and randomised into roles to participate in simulation-based, paediatric resuscitation. Participant workload was measured using the NASA Task Load Index, which provides an average workload score (from 0 to 100) across six subscores: mental demand, physical demand, temporal demand, performance, frustration and mental effort. Workload is considered low if less than 40, moderate if between 40 and 60 and high if greater than 60.ResultsThere were 210 participants representing 40 simulation teams. 138 residents (66%) and 72 nurses (34%) participated. Team lead reported the highest workload at 65.2±10.0 (p=0.001), while the airway reported the lowest at 53.9±10.8 (p=0.001); team lead had higher scores for all subscores except physical demand. Team lead reported the highest mental demand (p<0.001), while airway reported the lowest. Cardiopulmonary resuscitation coach and first responder reported the highest physical demands (p<0.001), while team lead and nurse recorder reported the lowest (p<0.001).ConclusionsWorkload for learners in paediatric simulated resuscitation teams was moderate to high and varied significantly based on team role. Composition of workload varied significantly by team role. Measuring learner workload during simulated resuscitations allows improved processes and choreography to optimise workload distribution.
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Affiliation(s)
- Ann L Young
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cara B Doughty
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Kaitlin C Williamson
- Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon K Won
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Marideth C Rus
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Nadia N Villarreal
- Pediatric Emergency Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth A Camp
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Daniel S Lemke
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
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How Much Cardiopulmonary Resuscitation Does a Pediatric Emergency Provider Perform in 1 Year? A Video-Based Analysis. Pediatr Emerg Care 2020; 36:327-331. [PMID: 30247459 DOI: 10.1097/pec.0000000000001625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We aimed to quantify time performing chest compressions (CCs) per year of individual providers in a pediatric ED and to project a rate of opportunity for CC based on median clinical hours per provider category. METHODS This was an observational study of video-recorded resuscitations in a pediatric ED over 1 year. Events where CCs were performed for more than 2 minutes were included. Identification of providers and duration of CCs per provider were determined by video review. Time of CCs was totaled per provider over the study period. Data were expressed as median and interquartile range (IQR). Rate of opportunity for providing CC to a child was calculated by dividing the median clinical hours per year per provider type by the number of CC events per year. RESULTS Twenty-three CC events totaling 340 minutes of CCs were analyzed. Chest compressions were performed by 6 (13%) of 45 attending physicians, 3 (25%) of 12 fellows, 32 (22%) of 143 nurses, and 19 (59%) of 32 technicians. The median amount of time performing CC was 182 seconds (IQR, 91-396 seconds); by provider category, median amount of time was as follows: attending physicians, 83 seconds (IQR, 64-103 seconds); fellows, 45 seconds (IQR, 6-83 seconds); nurses, 128 seconds (IQR, 93-271 seconds); and technicians, 534 seconds (IQR, 217-793 seconds). The projected hours needed for an opportunity to perform CCs was 730 hours (91 shifts) for attending physicians, 243 hours (30 shifts) for fellows, and 1460 hours (121 shifts) for nurses and technicians. CONCLUSIONS Performing CCs on children in the ED is a rare event, with a median of 3 minutes per provider per year. Future studies should determine training methods to optimize readiness for these rare occurrences.
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Analysis of CPR quality by individual providers in the pediatric emergency department. Resuscitation 2020; 153:37-44. [PMID: 32505613 DOI: 10.1016/j.resuscitation.2020.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/23/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To describe chest compression (CC) quality by individual providers in two pediatric emergency departments (EDs) using video review and compression monitor output during pediatric cardiac arrests. METHODS Prospective observational study. Patients <18 yo receiving CC for >1 min were eligible. Data was collected from video review and CC monitor device in a synchronized fashion and reported in 'segments' by individual providers. Univariate comparison by age (<1 yo, 1-8 yo, >8 yo) was performed by chi-square testing for dichotomous variables ('high-quality' CPR) and nonparametric testing for continuous variables (CC rate and depth). Univariate comparison of ventilation rate (V) was made between segments with an advanced airway versus without. RESULTS 524 segments had data available; 42/524 (8%) met criteria for 'high-quality CC'. Patients >8 yo had more segments meeting criteria (18% vs. 2% and 0.5%; p < 0.001). Segments compliant for rate were less frequent in <1 yo (17% vs. 24% vs. 27%; p = 0.03). Segments compliant for depth were less frequent in <1 year olds and 1-8 year olds (5% and 9% vs. 20%, p < 0.001.) Mean V for segments with an advanced airway was higher than with a natural airway (24 ± 18 vs. 14 ± 10 bpm, p < 0.001). Hyperventilation was more prevalent in CPR segments with an advanced airway (66% vs. 32%, p < 0.001). CONCLUSIONS CC depth is rarely guideline compliant in infants. Hyperventilation is more prevalent during CPR periods with an advanced airway in place. Measuring individual provider CPR quality is feasible, allowing future studies to evaluate the impact of CPR training.
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Videography in Pediatric Emergency Research: Establishing a Multicenter Collaborative and Resuscitation Registry. Pediatr Emerg Care 2020; 36:222-228. [PMID: 32356959 DOI: 10.1097/pec.0000000000001531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES High-quality clinical research of resuscitations in a pediatric emergency department is challenging because of the limitations of traditional methods of data collection (chart review, self-report) and the low frequency of cases in a single center. To facilitate valid and reliable research for resuscitations in the pediatric emergency department, investigators from 3 pediatric centers, each with experience completing successful single-center, video-based studies, formed the Videography In Pediatric Emergency Research (VIPER) collaborative. METHODS Our initial effort was the development of a multicenter, video-based registry and simulation-based testing of the feasibility and reliability of the VIPER registry. Feasibility of data collection was assessed by the frequency of an indeterminate response for all data elements in the registry. Reliability was assessed by the calculation of Cohen κ for dichotomous data elements and intraclass correlation coefficients for continuous data elements. RESULTS Video-based data collection was completed for 8 simulated pediatric resuscitations, with at least 2 reviewers per case. Data were labeled as indeterminate by at least 1 reviewer for 18 (3%) of 524 relevant data fields. The Cohen κ for all dichotomous data fields together was 0.81 (95% confidence interval, 0.61-1.0). For all continuous (time-based) variables combined, the intraclass correlation coefficient was 0.88 (95% confidence interval, 0.70-0.96). CONCLUSIONS Initial simulation-based testing suggests video-based data collection using the VIPER registry is feasible and reliable. Our next step is to assess feasibility and reliability for actual pediatric resuscitations and to complete several prospective, hypothesis-based studies of specific aspects of resuscitative care, including of cardiopulmonary resuscitation, tracheal intubation, and teamwork and communication.
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8
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Rubens JH, Ahmed OZ, Yenokyan G, Stewart D, Burd RS, Ryan LM. Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients. J Surg Res 2019; 246:153-159. [PMID: 31586889 DOI: 10.1016/j.jss.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/13/2019] [Accepted: 08/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS). MATERIALS AND METHODS We performed a retrospective cohort study at two level I pediatric trauma centers. INCLUSION CRITERIA <15 y old with blunt or penetrating injury. We used univariate and multivariate logistic regression analyses to determine associations between trauma activation, ED length of stay (LOS), and hospital LOS with demographic and clinical characteristics. RESULTS We identified 1161 patients: 40.1% arrived by self-transport and 59.9% by EMS. Self-transport patients were less likely to have an abnormal Glasgow Coma Scale score < 15 (2.1% versus 22.0%, P < 0.001) and Injury Severity Score > 15 (2.4% versus 11.7%, P < 0.001). Trauma activation was initiated in 52.5% of patients, occurring less often in self-transport than EMS patients (2.4% versus 86.2%, P < 0.001). Trauma activation rate was negatively associated with arrival by self-transport (odds ratio [OR] 0.001, 95% CI 0.00-0.003), positively associated with Glasgow Coma Scale <15 (OR 25.9, 95% CI 6.6-101.2) and site (OR 15.4, 95% CI 6.3-37.5) but not with Injury Severity Score >15 (OR 2.8, 95% CI 0.8-9.2). Self-transport arrival was associated with longer ED LOS (estimated regression slope 0.47, 95% CI 0.13-0.82). CONCLUSIONS Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.
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MESH Headings
- Child
- Child, Preschool
- Emergency Service, Hospital/organization & administration
- Emergency Service, Hospital/standards
- Emergency Service, Hospital/statistics & numerical data
- Facilities and Services Utilization/organization & administration
- Facilities and Services Utilization/standards
- Facilities and Services Utilization/statistics & numerical data
- Female
- Humans
- Injury Severity Score
- Length of Stay/statistics & numerical data
- Male
- Patient Admission/statistics & numerical data
- Practice Guidelines as Topic
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Registries/statistics & numerical data
- Retrospective Studies
- Transportation of Patients/statistics & numerical data
- Trauma Centers/organization & administration
- Trauma Centers/standards
- Trauma Centers/statistics & numerical data
- Triage/organization & administration
- Triage/standards
- Triage/statistics & numerical data
- United States
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/therapy
- Wounds, Penetrating/diagnosis
- Wounds, Penetrating/therapy
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Affiliation(s)
- Jessica H Rubens
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Omar Z Ahmed
- Department of Surgery, Children's National Health System, Washington, District of Columbia
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dylan Stewart
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Randall S Burd
- Department of Surgery, Children's National Health System, Washington, District of Columbia
| | - Leticia M Ryan
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Abstract
PURPOSE OF REVIEW The pediatric resuscitation environment is a high-stakes, environment in which a multidisciplinary team must work together with patient outcomes dependent, at least in part, on the performance of that team. Given constraints of the environment and the nature of these events, quality improvement work in pediatric resuscitation can be challenging. Ongoing collection of accurate and reliable data on team performance is necessary to inform and evaluate change. RECENT FINDINGS Despite the relative difficulty of quality improvement analysis and intervention implementation in the resuscitation environment, these efforts can have significant impact on patient outcomes. Although there are barriers to accurate data collection in real-life resuscitation, team performance of both technical and nontechnical skills can be reliably measured in video-based quality improvement programs. Training of nontechnical skills, using crisis resource management principles, can improve care delivery in resuscitation. SUMMARY Striving toward a learning healthcare system model in resuscitation care delivery can allow for efficient performance improvement. Given the possible impacts on mortality and quality of life of care delivered in the resuscitation environment, all providers who could possibly face a resuscitation event - no matter how rare - should consider how they are evaluating the quality of their care delivery in this arena.
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10
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Comparisons of Stress Physiology of Providers in Real-Life Resuscitations and Virtual Reality–Simulated Resuscitations. ACTA ACUST UNITED AC 2019; 14:104-112. [DOI: 10.1097/sih.0000000000000356] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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McLaughlin C, Wieck MM, Barin E, Rake A, Burke RV, Roesly HB, Young LC, Chang TP, Cleek EA, Morton I, Goodhue CJ, Burd RS, Ford HR, Upperman JS, Jensen AR. Impact of Simulation-Based Training on Perceived Provider Confidence in Acute Multidisciplinary Pediatric Trauma Resuscitation. Pediatr Surg Int 2018; 34:1353-1362. [PMID: 30324569 PMCID: PMC6353611 DOI: 10.1007/s00383-018-4361-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Simulation-based training has the potential to improve team-based care. We hypothesized that implementation of an in situ multidisciplinary simulation-based training program would improve provider confidence in team-based management of severely injured pediatric trauma patients. METHODS An in situ multidisciplinary pediatric trauma simulation-based training program with structured debriefing was implemented at a free-standing children's hospital. Trauma providers were anonymously surveyed 1 month before (pre-), 1 month after (post-), and 2 years after implementation. RESULTS Survey response rate was 49% (n = 93/190) pre-simulation, 22% (n = 42/190) post-simulation, and 79% (n = 150/190) at 2-year follow-up. These providers reported more anxiety (p = 0.01) and less confidence (p = 0.02) 1-month post-simulation. At 2-year follow-up, trained providers reported less anxiety (p = 0.02) and greater confidence (p = 0.01), compared to untrained providers. CONCLUSIONS Implementation of an in situ multidisciplinary pediatric trauma simulation-based training program may initially lead to increased anxiety, but long-term exposure may lead to greater confidence. LEVEL OF EVIDENCE II, Prospective cohort.
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Affiliation(s)
- Cory McLaughlin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Minna M Wieck
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Erica Barin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Alyssa Rake
- Division of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Rita V Burke
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Heather B Roesly
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - L. Caulette Young
- Division of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Todd P Chang
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Elizabeth A Cleek
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Inge Morton
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Catherine J Goodhue
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Randall S Burd
- Divisions of Trauma and Pediatric Surgery, Children’s National Medical Center, Washington, DC 20010
| | - Henri R Ford
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Jeffrey S Upperman
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Aaron R Jensen
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
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12
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The impact of the patient's initial NACA score on subjective and physiological indicators of workload during pre-hospital emergency care. PLoS One 2018; 13:e0202215. [PMID: 30092090 PMCID: PMC6084954 DOI: 10.1371/journal.pone.0202215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Excessive workload may impair patient safety. However, little is known about emergency care providers' workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). Therefore, we tested the hypothesis that subjective and physiological indicators of workload are associated with the patient's initial NACA score and that workload is particularly high during CPR. METHODS NASA task load index (NASA-tlx) and alarm codes were obtained for 216 sorties of pre-hospital emergency medical care. Furthermore, initial NACA scores of 140 patients were extracted from the physicians' protocols. The physiological workload indicators mean heart rate (HR) and permutation entropy (PeEn) were calculated for 51 sorties of primary care. General linear mixed models were used to analyze the association of NACA scores with subjective (NASA-tlx) and physiological (mean HR, PeEn) measures of workload. RESULTS In contrast to the physiological variables PeEn (p = 0.10) and HR (p = 0.19), the mental (p<0.001) and temporal demands (p<0.001) as well as the effort (p<0.001) and frustration (p = 0.04) subscale of the NASA-tlx were significantly associated with initial NACA scores. Compared to NACA = I, an initial NACA score of VI (representing CPR) increased workload by a mean of 389.5% (p = 0.001) in the mental and 345.9% (p<0.001) in the temporal demands, effort by a mean of 446,8% (p = 0.002) and frustration by 190.0% (p = 0.03). In line with the increase in NASA-tlx, PeEn increased by 20.6% (p = 0.01) and HR by 6.4% (p = 0.57). CONCLUSIONS Patients' initial NACA scores are associated with subjective workload. Workload was highest during CPR.
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Videographic Assessment of Pediatric Tracheal Intubation Technique During Emergency Airway Management. Pediatr Crit Care Med 2018; 19:e136-e144. [PMID: 29504951 DOI: 10.1097/pcc.0000000000001423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine technical aspects of pediatric tracheal intubation using video recording and to determine the association between tracheal intubation technique and procedural outcomes. DESIGN Prospective observational study. SETTING Emergency department resuscitation bay in single tertiary pediatric center. PATIENTS Children undergoing emergent tracheal intubation under videorecorded conditions. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A published scoring tool for characterizing patient positioning, intubator kinematics, and adjunctive maneuvers during tracheal intubation was applied to videorecorded pediatric resuscitations when tracheal intubation was performed. Procedural outcomes were measured from video review. Seventy-one children underwent 109 tracheal intubation attempts with an overall first attempt success rate of 69% and a median laryngoscopy duration of 34 seconds (interquartile range, 24-47 s). A significant subset of tracheal intubation attempts were made with the patient's bed at a height below the level of intubator's umbilicus (61%), the patient in a supine position without head elevation (55%), the intubator bent at the waist to greater than 45° (66%), less than 1 cm of mouth opening by the intubator's right hand prior to laryngoscopy (46%), and with the intubator's face less than 12 inches away from the patient's mouth (65%). Adjunctive maneuvers were used in a minority of attempts (cricoid pressure 48%, external laryngeal manipulation 11%, retraction of the right corner of the patient's mouth 26%). On multivariate analysis, including controlling for patient age category and intubator background, retraction of the right corner of the patient's mouth by an assistant showed an independent association with successful tracheal intubation. No other technical aspects were associated with tracheal intubation success. CONCLUSIONS Intubators commonly exhibited suboptimal technique during tracheal intubation such as bending deeply at the waist, having their eyes close to the patient's mouth, failing to widely open the patient's mouth, and not elevating the occiput in older children. Retraction of the right corner of the patient's mouth by an assistant during laryngoscopy and intubation was associated with TI success.
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Lapierre A, Gauvin-Lepage J, Lefebvre H. La collaboration interprofessionnelle lors de la prise en charge d’un polytraumatisé aux urgences : une revue de la littérature. Rech Soins Infirm 2017:73-88. [DOI: 10.3917/rsi.129.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
OBJECTIVE To develop a checklist for use during pediatric trauma resuscitation and test its effectiveness during simulated resuscitations. BACKGROUND Checklists have been used to support a wide range of complex medical activities and have effectively reduced errors and improved outcomes in different medical settings. Checklists have not been evaluated in the domain of trauma resuscitation. METHODS A focus group of trauma specialists was organized to develop a checklist for pediatric trauma resuscitation. This checklist was then tested in simulated trauma resuscitations to evaluate its impact on team performance. Resuscitations conducted with and without the checklist were compared using the Advanced Trauma Life Support (ATLS) performance score, designed to measure adherence to ATLS protocol, and surveys of team members' subjective workload. RESULTS The focus group generated a checklist with 56 items divided into 5 sections corresponding to different phases of trauma resuscitation. In simulation testing, the total ATLS performance score was 4.9 points higher with a checklist than without (P < 0.001), with most of this difference related to improvement in performance of the secondary survey (+3.3 points, P < 0.001). Overall, workload scores were not affected by the addition of the checklist. CONCLUSIONS Implementing a checklist during simulated pediatric trauma resuscitation improves adherence to the ATLS protocol without increasing the workload of trauma team members.
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Kelleher DC, Kovler ML, Waterhouse LJ, Carter EA, Burd RS. Factors affecting team size and task performance in pediatric trauma resuscitation. Pediatr Emerg Care 2014; 30:248-53. [PMID: 24651216 DOI: 10.1097/pec.0000000000000106] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Varying team size based on anticipated injury acuity is a common method for limiting personnel during trauma resuscitation. While missing personnel may delay treatment, large teams may worsen care through role confusion and interference. This study investigates factors associated with varying team size and task completion during trauma resuscitation. METHODS Video-recorded resuscitations of pediatric trauma patients (n = 201) were reviewed for team size (bedside and total) and completion of 24 resuscitation tasks. Additional patient characteristics were abstracted from our trauma registry. Linear regression was used to assess which characteristics were associated with varying team size and task completion. Task completion was then analyzed in relation to team size using best-fit curves. RESULTS The average bedside team ranged from 2.7 to 10.0 members (mean, 6.5 [SD, 1.7]), with 4.3 to 17.7 (mean, 11.0 [SD, 2.8]) people total. More people were present during high-acuity activations (+4.9, P < 0.001) and for patients with a penetrating injury (+2.3, P = 0.002). Fewer people were present during activations without prearrival notification (-4.77, P < 0.001) and at night (-1.25, P = 0.002). Task completion in the first 2 minutes ranged from 4 to 19 (mean, 11.7 [SD, 3.8]). The maximum number of tasks was performed at our hospital by teams with 7 people at the bedside (13 total). CONCLUSIONS Resuscitation task completion varies by team size, with a nonlinear association between number of team members and completed tasks. Management of team size during high-acuity activations, those without prior notification, and those in which the patient has a penetrating injury may help optimize performance.
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Affiliation(s)
- Deirdre C Kelleher
- From the Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC
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Kelleher DC, Jagadeesh Chandra Bose RP, Waterhouse LJ, Carter EA, Burd RS. Effect of a checklist on advanced trauma life support workflow deviations during trauma resuscitations without pre-arrival notification. J Am Coll Surg 2013; 218:459-66. [PMID: 24468229 DOI: 10.1016/j.jamcollsurg.2013.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/18/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Trauma resuscitations without pre-arrival notification are often initially chaotic, which can potentially compromise patient care. We hypothesized that trauma resuscitations without pre-arrival notification are performed with more variable adherence to ATLS protocol and that implementation of a checklist would improve performance. STUDY DESIGN We analyzed event logs of trauma resuscitations from two 4-month periods before (n = 222) and after (n = 215) checklist implementation. Using process mining techniques, individual resuscitations were compared with an ideal workflow model of 6 ATLS primary survey tasks performed by the bedside evaluator and given model fitness scores (range 0 to 1). Mean fitness scores and frequency of conformance (fitness = 1) were compared (using Student's t-test or chi-square test, as appropriate) for activations with and without notification both before and after checklist implementation. Multivariable linear regression, controlling for patient and resuscitation characteristics, was also performed to assess the association between pre-arrival notification and model fitness before and after checklist implementation. RESULTS Fifty-five (12.6%) resuscitations lacked pre-arrival notification (23 pre-implementation and 32 post-implementation; p = 0.15). Before checklist implementation, resuscitations without notification had lower fitness (0.80 vs 0.90; p < 0.001) and conformance (26.1% vs 50.8%; p = 0.03) than those with notification. After checklist implementation, the fitness (0.80 vs 0.91; p = 0.007) and conformance (26.1% vs 59.4%; p = 0.01) improved for resuscitations without notification, but still remained lower than activations with notification. In multivariable analysis, activations without notification had lower fitness both before (b = -0.11, p < 0.001) and after checklist implementation (b = -0.04, p = 0.02). CONCLUSIONS Trauma resuscitations without pre-arrival notification are associated with a decreased adherence to key components of the ATLS primary survey protocol. The addition of a checklist improves protocol adherence and reduces the effect of notification on task performance.
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Affiliation(s)
- Deirdre C Kelleher
- Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC
| | - R P Jagadeesh Chandra Bose
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Lauren J Waterhouse
- Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC
| | - Elizabeth A Carter
- Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC.
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The Evolving Role of the Radiologist: The Vancouver Workload Utilization Evaluation Study. J Am Coll Radiol 2013; 10:764-9. [DOI: 10.1016/j.jacr.2013.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/02/2013] [Indexed: 11/22/2022]
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