The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Initial Experience of a Respiratory Care Focused Program of Medical simulation in a pedatric teaching hospital

Barry Grenier, RRT, Liana Stanley, MEd, Lindsay Farragher, Jeffrey Burns, MD. Children’s Hospital Boston and Harvard Medical School, Boston, MA

Background: Sophisticated simulation environments are routinely used for military training and for training airline pilots. Similar training is increasingly being used to teach crisis resource management (CRM) to medical personnel in the critical care environment.

Methods: New staff therapists (< 3 years in department) participated in a battery of 4 critical care scenarios: a multi-disciplinary CRM (code team) scenario followed by three scenarios specific to respiratory critical care. These included an endotracheal tube emergency, initiation of pediatric high frequency oscillatory ventilation (HFOV), and a tracheostomy-related scenario. Veteran therapists (> 3 years in department), directed to act as a resource to the new staff, also participated in the HFOV scenario. Each scenario was followed by a facilitator-led analysis (debriefing session) utilizing video tape of the scenario. Participants completed post-simulation questionnaires that included general qualitative questions regarding the program and debriefing as well as a self-assessment of critical care teamwork skills, assessment and management skills, and the ability to deliver safer patient care. All responses were based on a 5 point Likert scale (1-strongly disagree to 5-strongly agree).

Results: Twenty therapists (10 new staff, 10 veteran staff) participated. Differences in the responses between the 2 groups of therapists were not significant (p = .135). Twenty questionnaire items were grouped into 5 distinct categories. Subgroups of items were combined into a composite statement for each category.

Evaluation Categories Median (Range)*
1. The scenarios were realistic and believable. 4 (4 -5)
2. The debriefings were open, non-threatening, and informative. 4 (4 -5)
3. The program improved therapist communication and teamwork skills. 4 (3 -5)
4. The program will help therapists provide safer patient care. 4 (3 -5)
5. Therapists feel better prepared to assess and manage critical care situations. 4 (3 -5)

* Response range: 1 (strongly disagree) to 5 (strongly agree)

Conclusions: The RC staff found the simulation scenarios realistic and the debriefing process open, non-threatening, and informative. Both new and veteran staff self-reported: 1) improved critical care communication and team work skills; 2) improved ability to provide safe patient care; and 3) improved ability to assess and manage critical patient care situations.

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