INSPIRE @ IMSH 2015 ALERTs

ALERT Presentation: Integrating Cognitive Aids (INCA)

Dylan Bould, Sylvain Boet, Farhan Bhanji, Adam Cheng

University of Ottawa, McGill, University of Calgary

INSPIRE @ IMSH 2015 – New Orleans, LA / USA

International Network for Simulation-based Pediatric Innovation, Research and Education

• Knowledge-based cognitive aids (CA) have

the potential to improve performance

• Previous research has neglected their

implementation in actual interprofessional

teams

• We have developed a novel team-based CA


Background

• P: interprofessional teams in emergency and critical

care

• I: (factorial) knowledge-based CA, team-based CA,

integration of both

• C: no CA provided

• O: adherence to PALS algorithm (measured by

Clinical Performance Tool)


PICO / Research Question


Approach / Design

• ALERT Presentation – January 2015

• Grant Proposal(s) – in progress – hope funding Spring 2015

• IRB Submission – Spring 2015

• Recruitment / Data Collection – Summer 2015

• Data Analysis – Summer 2016

• Abstract Presentation – Late 2016

• Manuscript Preparation – Late 2016


Timeline

1.What is the most compelling outcome

measure to get large grants

2.Ideas for instructional design/format of

e-Learning module

3.Can you see any “sub-studies”?


3 questions to improve study

At INSPIRE @ IMSH 2015:

Find collaborating centers

In 2 months: (hope) receive funding and

start pilots at lead site


Goals to accomplish

Dylan Bould

Children’s Hospital of Eastern Ontario,

University of Ottawa

[email protected]


Contact Information

mailto:[email protected]

The effect of summative feedback on the accuracy of provider perceptions and the quality

of CPR during a simulated pediatric cardiac arrest.

Linda L. Brown, MD MSCE and Adam Cheng, MD

Hasbro Children’s Hospital / Brown University

Alberta Children’s Hospital / University of Calgary



• Quality CPR is a crucial component in survival from

pediatric cardiac arrest

• Healthcare providers (HCP) are

often unaware of the quality of their

CPR, even with real-time CPR feedback (VisF)

• Summative feedback may improve skills, but little is

known about its effect on CPR quality


Background

• P: CPR certified healthcare providers

• I: Summative feedback regarding the

quality of CPR

• C: HCP with no summative feedback

• O: Improved quality of CPR and

improved accuracy of HCP perceptions




Approach / Design

CPR trained HCP

(randomized)

Control

Pediatric Cardiac Arrest Scenario

With VisF

Collect data on CPR

Collect HCP perceptions

Debrief

Pediatric Cardiac Scenario #2

Collect data on CPR


Debrief

Intervention

Pediatric Cardiac Arrest Scenario

With VisF

Collect data on CPR


Debrief with summative feedback

Pediatric Cardiac Arrest Scenario #2

Collect data on CPR


Debrief with summative feedback

• ALERT Presentation 1/15

• Grant Proposal (if applicable) 2/15

• IRB Submission 2/15

• Recruitment / Data Collection Dependent on funding

• Data Analysis

• Abstract Presentation

• Manuscript Preparation


Timeline

1. What should be included for follow-up?

1. Another scenario

2. Individual HCP CPR

2. Time frame for follow-up?

3. Is this objective enough?




Refine/optimize research protocol

Input from group

In 2 months: Complete grant applications


Goals to accomplish

Linda L. Brown, MD MSCE

Alpert Medical School of Brown

University/Hasbro Children’s Hospital

[email protected]

401-444-6237


Contact Information


ALERT Presentation: The use of Leaderboards & Competition to

improve self-initiated CPR training

Todd P Chang, MD MAcM Children’s Hospital Los Angeles

Ralph J MacKinnon, MD Royal Manchester Children’s Hospital



• Rolling self-initiated refreshers on CPR algorithms appear to

improve skill (Kurosawa et al. 2014)

• A clustering effect is seen when participants within a unit can

compare CPR skill results using a Laerdal Q-CPR Mannequin

(MacKinnon et al.)

• We observed that friendly competition appears to increase a la

carte practice of CPR up to 3 months


Background

• P: Healthcare providers (ICU, OR-Theatre, ED-A&E)

• I: Access to Leaderboard & other units’ & institutions’ scores

• C: Access only to own scores

• O1: Usage Frequency

• O2: CPR Technique

– Calculated score (%)

– Depth (mm)

– Recoil (mm, %)

– Rate (per minute)




Approach

Recruit

Institutions


Approach

Recruit

Institutions

Randomize

Institutions


Approach

Recruit

Institutions

Randomize

Institutions

All Sites allow self-initiated

CPR training using QCPR


Approach

Recruit

Institutions

Randomize

Institutions



Intervention Sites have

access to scores from all

participating institutions


Approach

Recruit

Institutions

Randomize

Institutions



Intervention Sites have

access to scores from all

participating institutions

Control Sites only have

access to individual score

1. Healthcare Providers & Institutions with access to a

Leaderboard increases the usage frequency of QCPR

mannequins

2. Healthcare Providers & Institutions with access to a

Leaderboard improves CPR technique as measured by the

QCPR Score


Hypotheses


Timeline

ALERT Presentation 01.10.2015 IMSH 2015

Recruiting Sites 01 – 05.2015

Sites Pilot / Logistics 01 – 06.2015

Laerdal Foundation Grant due 04.15.2015 Other Grants too…

Protocol Finalized 05.04.2015 IPSSW 2015

IRB Submissions 06.xx.2015

Data Collection 07.2015 – 06.2016 Depending on grants

Interim Analysis 10.2015 – 12.2015 Depending on grants

Update Meeting 01.xx.2016 IMSH 2016

Abstracts 04.2016 – 10.2016 IPSSW , etc.

Manuscript(s) Winter 2016

1. How to make / update Leaderboard?

2. Local rivalries or Int’l competition?

3. Other funding sources?




1. Recruit sites

2. Identify authorship, grants

3. Begin grantwriting & pilot phases

In 2 months:

1. Prepare for IPSSW updates

2. Drafts of Grants & Pilot data analysis


Goals to accomplish

Todd P Chang, MD MAcM

[email protected]

http://www.inspiresim.com/


Contact Information


Progress Report Presentation: Development of simulation-based assessment tools for the general

pediatrics milestones

Leah Mallory, MD

The Barbara Bush Children’s Hospital

at Maine Medical Center

IMSH 2015: New Orleans, LA / USA


• For the 21 milestones sub-competencies,

identify:

1. gaps in existing assessment tools and

2. best opportunities for simulation-based assessment

• Where the 2 overlap, create and validate

simulation-based assessment tools


Aim(s) - Revised

• August 2014- IRB exemption obtained for survey phase of project

• September 2014- survey of pediatric simulation experts

• October 2014- collaborate with APPD Simulation PEG to survey pediatric

program directors through APPD

• December 2015- from survey results, created “milestones-aligned wish

list” for simulation-based assessment tools

• January 2015- begin developing assessment tools in 3 prioritized areas

• Spring 2015- present (IPSSW) and publish survey data

pilot and continue to refine assessment tools

• Summer/Fall 2015- establish reliability and validity of assessment tools

across multiple sites


Timeline & Current progress

1. Some of these areas/sub-competencies are difficult to assess,

need to link observable, specific behaviors to be able to

assess (e.g. insight into own strengths and weaknesses)

2. Possible to reliably distinguish between “novice” and “expert”

in these categories?

3. In simulation setting, how to distinguish between individual and

team performance?

4. How to create a practically useful assessment tool (not too

long, not requiring extensive “train the trainer” input, that is

also reliable and valid?


Needs / Challenges


Use break-out group to develop first version of

assessment tool for 3 identified areas

In upcoming 3 months:

Pilot and refine assessment tools

Later 2015:

Establish reliability and validity across multiple sites


Goals to accomplish

Name: Leah Mallory, MD

Institution: The Barbara Bush Children’s

Hospital at Maine Medical Center

E-mail: [email protected]

Phone: 207-662-1504


Contact Information


ALERT Presentation: Resuscitating Teamwork and Safety Using

Acute Event DebriefingMichael-Alice Moga MD, Mary McBride MD, Genny Frey RN,

Dana Schnasi MD, Walter Eppich MD, MEd

Ann & Robert H. Lurie Children’s Hospital of Chicago

Northwestern University Feinberg School of Medicine



• ICU-based teamwork and safety culture remain suboptimal

• Safety culture has been linked to patient outcomes

• Outcomes after in-hospital pediatric cardiac arrest remain

disappointing

• From 2009-2014, only 38% of codes in our cardiac population

possessed 6 elements of quality:

– Teamwork: closed-loop communication, identified leader, noise control

– Lack of technical errors, equipment malfunction, systems failure


Background


Patients suffering a cardiac arrest in the ICU

Nurse-led, acute event debriefing

Pre-intervention (?PICU)

Teamwork, safety culture, code quality, patient

outcomes

P

I

C

O



Approach / Design

• Tool development

• Train charge RNs in cardiac ICU

• Test debriefing during in situ simulations

Design/proof of concept

• Integrate into current CQI with cold briefs

• PDSA cycles

Implement & integrate

• Debrief Metrics: who, what, when, where, how

• Code metrics: quality metrics, GWTG, outcomes

• Unit-metrics: Safety / teamwork questionnaires

• Dissemination: PICUICU RN-led debriefs of all housewide codes

Evaluate ±expand

Current Continuous Quality Review

40

Code

Data collection and entry

1. Real-time

2. Delayed chart review

3. Database entry

Code Review Committee

1. Standardized presentation

2. QI discussion

3. Data entry-QI components

Follow Up

1. Education

2. Team feedback

3. Quality Improvement

Hotwash

• ALERT Presentation: January 2015

• Grant Proposal (if applicable): 2015/early 2016

• IRB Submission: March 2015

• Recruitment / Data Collection: April 2015 onwards for patients

• Data Analysis: ongoing

• Abstract Presentation: Concept/pilot-Fall 2015

• Manuscript Preparation: Concept/pilot-Fall 2015-2016


Timeline

1. What are pitfalls and barriers others have

encountered with debriefing?

2. Best study design after proof of conceot/pilot

3. Are we covering a good range of outcomes?

Too many, too few?




-Network with others doing in situ debriefs

-Feedback on tool, potential funding sources

In 2 months:

-Initial data for Capstone presentation

-Have “proof of concept” with Tool, Training and

Testing done


Goals to accomplish

Michael-Alice Moga, MD

Ann & Robert H. Lurie Children’s Hospital of Chicago,

Northwestern University Feinberg School of Medicine

[email protected]

312-227-1551


Contact Information


ALERT Presentation: The use of Leaderboards & Competition to

improve High School CPR training

Ralph J MacKinnon, MD Royal Manchester Children’s Hospital

Todd P Chang, MD MAcM Children’s Hospital Los Angeles



• Excellent School CPR programs exist globally base hospitals

• Rolling self-initiated refreshers on CPR algorithms appear to

improve skill (Kurosawa et al. 2014)

• A clustering effect is seen when participants within a unit can

compare CPR skill results using a Laerdal Q-CPR Mannequin

(MacKinnon et al.)

• Friendly competition appears to increase a la carte practice of CPR

up to 3 months


Background

• P: High School

• I: Access to Leaderboard & other teams & school’s scores

• C: Participants – own controls

• O1: Usage Frequency

• O2: CPR Technique

– Calculated score (%)

– Depth (mm)

– Recoil (mm, %)

– Rate (per minute)



1. Competition sustains & promotes learning across school

year

2. Access to a Leaderboard & QCPR mannequins improves

CPR performance by high school pupils


Hypotheses


Approach

Recruit High

Schools around

Institutions


Longitudinal cohort study

Recruit

Institutions

Promote

competition

globally


Approach

Recruit

Institutions

Promote

competition

globally

Baseline score capture


Approach

Recruit

Institutions

Promote

competition

globally


Weekly score upload


Approach

Recruit

Institutions

Promote

competition

globally


Weekly score upload

Process engagement tracking


Approach

Recruit

Institutions

Promote

competition

globally


Weekly score upload

Process engagement tracking

Outcome measurement


Timeline

ALERT Presentation 01.10.2015 IMSH 2015

Recruiting Sites 11.2014 – 05.2015 Commenced

Sites Pilot / Logistics 01 – 06.2015

Laerdal Foundation Grant due 04.15.2015 Other Grants too…

Protocol Finalized 05.04.2015 IPSSW 2015

IRB Submissions 06.xx.2015

Data Collection 07.2015 – 06.2016 Depending on grants

Interim Analysis 10.2015 – 12.2015 Depending on grants

Update Meeting 01.xx.2016 IMSH 2016

Abstracts 04.2016 – 10.2016 IPSSW , etc.

Manuscript(s) Winter 2016

1. How to make / update Leaderboard?

2. Measurement of social media

engagement?

3. Introduction of interventions over the

year?




1. Recruit sites

2. Identify authorship, grants

3. Begin grant writing & pilot phases

In 2 months:

1. Prepare for IPSSW updates

2. Drafts of Grants & Pilot data analysis


Goals to accomplish

Ralph MacKinnon

[email protected]

http://www.inspiresim.com/


Contact Information

Pediatric Simulation in Rural India: PedSRI Study

Dr Sujatha Thyagarajan,

Dr Rakshay Shetty

Dr Geethanjali Ramachandra

PediSTARS India



• Simulation in Pediatrics is not an established

method of training in India, though there is a

felt need to inculcate it.

• The utility to employ this method in a rural

set-up is even more challenging.


Background

• P: Pediatric patients 1m to 16 years presenting to ER in a rural

hospital and require transfer to a higher centre

• I: Structured Simulation training programme to address

recognition, stabilisation and transfer to a higher centre

• C: Pre-intervention and post-intervention with the simulation

training programme over a 6 months period each

• O: Staff competence (?) and patient outcomes – LOS, mortality;



• A pilot study of implementing a structured simulation programme

for 4 most common pediatric emergencies seen in a rural set up

was conducted by PediSTARS India in June 2014;

• Many lessons learnt and encouraging enthusiasm by

participants

• Now a structured approach to study the impact w.r.t patient

outcomes


Approach / Design

• ALERT Presentation - Jan 2015

• Grant Proposal (if applicable)

• IRB Submission – Mar 2015

• Recruitment / Data Collection – May – Oct 2015 for pre-

intervention data and post intervention Jan 2016 – June 2016

• Data Analysis – July 2016 – Aug 2016

• Abstract Presentation – Sep 2016

• Manuscript Preparation – Sep – Dec 2016


Timeline

1. What would be the best simulation programme

structure?

2. What would be the best way to study the impact of

simulation in a rural set up in India ? – sustainability is

the key

3. What outcomes study will best reflect the utility of

simulation in rural set up?



At INSPIRE @ IMSH 2015: Study details

In 2 months: Research proposal,

implementation and local support


Goals to accomplish

Name : Dr Sujatha Thyagarajan

Institution: PediSTARS India

E-mail, Phone: [email protected]

Website: www.pedistarsindia.com


Contact Information

Date post:	16-Jul-2015
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INSPIRE @ IMSH 2015 ALERTs

Science