A. J. Sochan1, A. Brun2, K. Delaney3, L. Popick3, S. Cardozo-Stolberg4, R. Panesar5, C. Russo4, H. Hsieh4 1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA 2Binghamton University, Binghamton, NY, USA 3Stony Brook University Medical Center, Department Of Emergency Medicine, Stony Brook, NY, USA 4Stony Brook University Medical Center, Department Of Surgery, Stony Brook, NY, USA 5Stony Brook University Medical Center, Department Of Pediatrics, Stony Brook, NY, USA
Introduction: Continuous performance improvement (PI) programs are essential to maintain excellence in trauma care. Effective PI requires identification, evaluation, and implementation at multiple levels within a healthcare institution. As an adjunct to our institutional PI process, we have integrated PI issues identified from actual trauma cases into an in-situ trauma simulation program. This is a pilot study exploring the efficacy of high-fidelity pediatric trauma simulations in improving self-reported provider comfort, skills, and knowledge for identified trauma PI issues.
Methods: This study involves an integrated PI program at an American College of Surgeons (ACS)-verified Level I Pediatric Trauma Center. During the PI evaluation of a pediatric trauma code patient treated in the emergency department (ED), several PI issues were identified, including the management of increased intracranial pressure (ICP) and the use of massive transfusion protocols (MTP). Several points of improvement were identified: hospital policies were updated, provider education modules were implemented, and clinical protocols were improved. To close the loop on major PI issues identified, a clinical curriculum and trauma simulations were developed as per the Association of American Medical Colleges (AAMC) guidelines. Multiple mock trauma codes were called, and in-situ trauma simulations addressing the PI issues were held. Simulation participants included all services involved in trauma codes within the ED. In-depth discussions involving PI for elevated ICP and MTP occurred post-simulation. Participants completed a pre- and post-simulation survey. Univariate statistics are presented.
Results: Overall, 23 providers participated in the pediatric trauma simulations (7 residents, 7 nurses, 8 paramedics, and 1 respiratory therapist). Self-reported provider comfort using a Likert scale improved from pre- to post-simulation (p=0.02) and trauma skills and knowledge improved from 72% pre-simulation to 96% post-simulation (p<0.01).
Conclusion: High-fidelity pediatric trauma simulations enhance provider comfort, knowledge, and skills in trauma scenarios. By integrating high-fidelity trauma simulations to address clinical issues identified in the trauma PI process, provider education can be reinforced and practiced in a controlled environment to improve trauma care. Future studies evaluating the implementation of clinical pathways and patient outcomes are needed to demonstrate the effectiveness of simulations in PI pathways.