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. 2020 Dec 28;6(1):e373.
doi: 10.1097/pq9.0000000000000373. eCollection 2021 Jan-Feb.

Simulation to Train Pediatric ICU Teams in Endotracheal Intubation of Patients with COVID-19

Shilpa C Balikai  1 , Aditya Badheka  1 , Andrea Casey  2 , Eric Endahl  2 , Jennifer Erdahl  2 , Lindsay Fayram  2 , Amanda Houston  2 , Paula Levett  2 , Howard Seigel  2 , Niranjan Vijayakumar  1 , Christina L Cifra  1
Affiliations

Simulation to Train Pediatric ICU Teams in Endotracheal Intubation of Patients with COVID-19

Shilpa C Balikai et al. Pediatr Qual Saf. .

Abstract

To prevent transmission of severe acute respiratory syndrome coronavirus 2 to healthcare workers, we must quickly implement workflow modifications in the pediatric intensive care unit (PICU). Our objective was to rapidly train interdisciplinary PICU teams to safely perform endotracheal intubations in children with suspected or confirmed coronavirus disease 2019 using a structured simulation education program.

Methods: We conducted a quality improvement study in a tertiary referral PICU. After developing stakeholder-driven guidelines for modified intubation in this population, we implemented a structured simulation program to train PICU physicians, nurses, and respiratory therapists. We directly observed PICU teams' adherence to the modified intubation process before and after simulation sessions and compared participants' confidence using the Simulation Effectiveness Tool-Modified (SET-M, Likert scale range 0: do not agree to 2: strongly agree regarding statements of confidence).

Results: Fifty unique PICU staff members participated in 9 simulation sessions. Observed intubation performance improved, with teams executing a mean of 7.3-8.4 out of 9 recommended practices between simulation attempts (P = 0.024). Before undergoing simulation, PICU staff indicated that overall they did not feel prepared to intubate patients with suspected or confirmed SARS-CoV-2 (mean SET-M score 0.9). After the simulation program, PICU staff confidence improved (mean SET-M score increased from 0.9 to 2, P < 0.001).

Conclusion: PICU teams' performance and confidence in safely executing a modified endotracheal intubation process for children with suspected or confirmed SARS-CoV-2 infection improved using a rapidly deployed structured simulation education program.

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Conflict of interest statement

The Agency for Healthcare Research and Quality (AHRQ) supports Dr. Cifra under grant #K08HS026965. She receives additional support from an internal start-up grant from the University of Iowa Carver College of Medicine Department of Pediatrics. The content of this work is solely the authors’ responsibility and does not necessarily represent the official views of the AHRQ. The other authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Design and evaluation of a quality improvement project using simulation to train pediatric intensive care unit teams in endotracheal intubation of patients with suspected or confirmed SARS-CoV-2 infection.
See this image and copyright information in PMC

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