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. 2022 Jul 26:10:904846.
doi: 10.3389/fped.2022.904846. eCollection 2022.

Low-Cost "Telesimulation" Training Improves Real Patient Pediatric Shock Outcomes in India

Ebor Jacob G James  1   2 , Siva Vyasam  1 , Shakthi Venkatachalam  3 , Elizabeth Sanseau  4 , Kyle Cassidy  5 , Geethanjali Ramachandra  2   6 , Grace Rebekah  7 , Debasis D Adhikari  1 , Ellen Deutsch  3   8 , Akira Nishisaki  3   8 , Vinay M Nadkarni  3   8
Affiliations

Low-Cost "Telesimulation" Training Improves Real Patient Pediatric Shock Outcomes in India

Ebor Jacob G James et al. Front Pediatr. .

Abstract

Introduction: Pediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcome. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COVID-19 pandemic restrictions on in-person simulation led us to the development of telesimulation for shock. We hypothesized that telesimulation training would improve pediatric shock recognition, process of care, and patient outcomes in both simulated and real patient settings.

Materials and methods: We conducted a prospective quasi-experimental interrupted time series cohort study over 9 months. We conducted 40 telesimulation sessions for 76 participants in teams of 3 or 4, utilizing the video telecommunication platform (Zoom©). Trained observers recorded time-critical interventions on real patients for the pediatric emergency teams composed of residents, fellows, and nurses. Data were collected on 332 pediatric patients in shock (72% of whom were in septic shock) before, during, and after the intervention. The data included the first hour time-critical intervention checklist, patient hemodynamic status at the end of the first hour, time for the resolution of shock, and team leadership skills in the emergency room.

Results: There was a significant improvement in the percent completion of tasks by the pediatric emergency team in simulated scenarios (69% in scenario 1 vs. 93% in scenario 2; p < 0.001). In real patients, completion of tasks as per time-critical steps reached 100% during and after intervention compared to the pre-intervention phase (87.5%), p < 0.05. There was a significant improvement in the first hour hemodynamic parameters of shock patients: pre (71%), during (79%), and post (87%) intervention (p < 0.007 pre vs. post). Shock reversal time reduced from 24 h pre-intervention to 6 h intervention and to 4.5 h post intervention (p < 0.002). There was also a significant improvement in leadership performance assessed by modified Concise Assessment of Leader Management (CALM) instrument during the simulated (p < 0.001) and real patient care in post intervention (p < 0.05).

Conclusion: Telesimulation training is feasible and improved the process of care, time-critical interventions, leadership in both simulated and real patients and resolution of shock in real patients. To the best of our knowledge, this is one of the first studies where telesimulation has shown improvement in real patient outcomes.

Keywords: COVID-19 educational innovations; hotkeys; septic shock; simulation-based education; telesimulation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The scheme of telesimulation sessions.
FIGURE 2
FIGURE 2
Telesimulation session showing pictures of real patient video clips with participants and facilitators meeting on the video conferencing platform Zoom©.
FIGURE 3
FIGURE 3
Telesimulation session showing video of a real healthcare teams in the emergency room responding to a patient with shock.
FIGURE 4
FIGURE 4
Approach and design of the telesimulation study in the emergency room.
FIGURE 5
FIGURE 5
Algorithm depicting the flow of the telesimulation study in the emergency room.
FIGURE 6
FIGURE 6
Comparison of percent task completion checklist score of time-critical steps in the first-hour management of shock between the two telesimulation sessions.
FIGURE 7
FIGURE 7
Comparison of leadership assessment by the modified CALM tool of ER team during the first-hour management of shock between the two telesimulation sessions.
FIGURE 8
FIGURE 8
Hemodynamic stabilization at the end of the first hour.
FIGURE 9
FIGURE 9
Median percent completion of task as per checklist during the first-hour management of shock in real patient events in the emergency room. UCL, upper control limit; CL, center line; LCL, lower control limit.
FIGURE 10
FIGURE 10
Median CALM score (leadership assessment) during the first-hour management of shock in real patient events in the emergency room UCL, upper control limit; CL, center line; LCL, lower control limit.
FIGURE 11
FIGURE 11
Median shock reversal time in real patient events UCL, upper control limit; CL, center line; LCL, lower control limit.
FIGURE 12
FIGURE 12
Development of Multiple Organ Dysfunction Syndrome (MODS) in patients with shock.
See this image and copyright information in PMC

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