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

Fenton O'Leary; Kathryn McGarvey; Andrea Christoff; Jennifer Major; Francis Lockie; Gilad Chayen; John Vassiliadis; Sally Wharton

doi:10.1016/j.resuscitation.2013.12.001

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

Resuscitation. 2014 Mar;85(3):431-6. doi: 10.1016/j.resuscitation.2013.12.001. Epub 2013 Dec 7.

Authors

Fenton O'Leary¹, Kathryn McGarvey², Andrea Christoff³, Jennifer Major³, Francis Lockie³, Gilad Chayen³, John Vassiliadis⁴, Sally Wharton⁵

Affiliations

¹ Emergency Department, The Children's Hospital at Westmead, Sydney, Australia; Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, University Of Sydney, Australia. Electronic address: fenton.oleary@health.nsw.gov.au.
² Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, University Of Sydney, Australia.
³ Emergency Department, The Children's Hospital at Westmead, Sydney, Australia.
⁴ Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, University Of Sydney, Australia; Sydney Clinical Skills and Simulation Centre, Sydney, Australia.
⁵ Anaesthetic Department, The Children's Hospital at Westmead, Sydney, Australia.

PMID: 24321323
DOI: 10.1016/j.resuscitation.2013.12.001

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: Incidents of suboptimal care; Paediatric emergencies; Simulation.

Publication types

Observational Study

MeSH terms

Child
Emergency Treatment / standards*
Humans
Patient Simulation*
Prospective Studies
Quality of Health Care*