Elsevier

Resuscitation

Volume 85, Issue 3, March 2014, Pages 431-436
Resuscitation

Simulation and education
Identifying incidents of suboptimal care during paediatric emergencies–an observational study utilising in situ and simulation centre scenarios

https://doi.org/10.1016/j.resuscitation.2013.12.001Get rights and content
Under a Creative Commons license
open access

Abstract

Aim

Life threatening paediatric emergencies are relatively uncommon events. When they do occur staff caring for these children must have the ability to recognise the deterioration, evaluate and simultaneously treat these patients. The aim of this study was to identify suboptimal care during standardised simulated scenarios and to identify the potential causation factors.

Methods

Participants were emergency department and operating theatre staff in Sydney, Australia. Incidents of suboptimal care were identified during scenarios and were analysed by thematic qualitative assessment methods. Potential causation factors were elicited both during and immediately after the scenarios and during facilitated debriefings. Causation factors were attributed to any of seven pre-defined categories.

Results

Seventy-three simulations occurred over 9 month period in 2011. 270 doctors, 235 nurses and 11 students participated. 194 incidents of suboptimal care were observed and attributed to 325 causation factors. There were 76 knowledge deficits, 39 clinical skill deficits, 36 leadership problems, 84 communication failures, 20 poor resource utilisations, 23 preparation and planning failures and 47 incidents of a loss of situational awareness. Clinically important themes were: paediatric life support, drug choice and doses, advanced airway and ventilation, intravenous fluids and recognition of the deteriorating patient. Recurring incidents included the failure to recognise a cardiac arrest, inadequate fluid resuscitation and incorrect medication dose administration.

Conclusions

During standardised paediatric simulations multiple incidents of suboptimal care have been identified and multiple causation factors attributed to these. Educators should use this information to adapt current training programs to encompass these factors.

Keywords

Paediatric emergencies
Incidents of suboptimal care
Simulation

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A spanish translated version of the summary of this article appears as appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.12.001.