2 results
Paediatric resident identification of cardiac emergencies
- Brittney K. Hills, Dana B. Gal, Matthew Zackoff, Brenda Williams, Elisa Marcuccio, Melissa Klein, Ndidi Unaka
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- Journal:
- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 22 April 2024, pp. 1-6
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Objectives:
Critical CHD is associated with morbidity and mortality, worsened by delayed diagnosis. Paediatric residents are front-line clinicians, yet identification of congenital CHD remains challenging. Current exposure to cardiology is limited in paediatric resident education. We evaluated the impact of rapid cycle deliberate practice simulation on paediatric residents’ skills, knowledge, and perceived competence to recognise and manage infants with congenital CHD.
Methods:We conducted a 6-month pilot study. Interns rotating in paediatric cardiology completed a case scenario assessment during weeks 1 and 4 and participated in paired simulations (traditional debrief and rapid cycle deliberate practice) in weeks 2–4. We assessed interns’ skills during the simulation using a checklist of “cannot miss” tasks. In week 4, they completed a retrospective pre-post knowledge-based survey. We analysed the data using summary statistics and mixed effect linear regression.
Results:A total of 26 interns participated. There was a significant increase in case scenario assessment scores between weeks 1 and 4 (4, interquartile range 3–6 versus 8, interquartile range 6–10; p-value < 0.0001). The percentage of “cannot miss” tasks on the simulation checklist increased from weeks 2 to 3 (73% versus 83%, p-value 0.0263) and from weeks 2–4 (73% versus 92%, p-value 0.0025). The retrospective pre-post survey scores also increased (1.67, interquartile range 1.33–2.17 versus 3.83, interquartile range 3.17–4; p-value < 0.0001).
Conclusion:Rapid cycle deliberate practice simulations resulted in improved recognition and initiation of treatment of simulated infants with congenital CHD among paediatric interns. Future studies will include full implementation of the curriculum and knowledge retention work.
Initiative to increase family presence and participation in daily rounds on a paediatric acute care cardiology unit
- Dana B. Gal, Colleen M. Pater, Mackenzie McGinty, Greta Lobes, Christy Tuemler, Paula M. Eldridge, Brittany Frakes, Elisa Marcuccio, Samuel P. Hanke, Michael G. Gaies
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- Journal:
- Cardiology in the Young / Volume 34 / Issue 1 / January 2024
- Published online by Cambridge University Press:
- 04 May 2023, pp. 44-49
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Introduction:
Family-centred rounds benefit families and clinicians and improve outcomes in general paediatrics, but are understudied in subspecialty settings. We sought to improve family presence and participation in rounds in a paediatric acute care cardiology unit.
Methods:We created operational definitions for family presence, our process measure, and participation, our outcome measure, and gathered baseline data over 4 months of 2021. Our SMART aim was to increase mean family presence from 43 to 75% and mean family participation from 81 to 90% by 30 May, 2022. We tested interventions with iterative plan-do-study-act cycles between 6 January, 2022 and 20 May, 2022, including provider education, calling families not at bedside, and adjustment to rounding presentations. We visualised change over time relative to interventions with statistical control charts. We conducted a high census days subanalysis. Length of stay and time of transfer from the ICU served as balancing measures.
Results:Mean presence increased from 43 to 83%, demonstrating special cause variation twice. Mean participation increased from 81 to 96%, demonstrating special cause variation once. Mean presence and participation were lower during high census (61 and 93% at project end) but improved with special cause variation. Length of stay and time of transfer remained stable.
Conclusions:Through our interventions, family presence and participation in rounds improved without apparent unintended consequences. Family presence and participation may improve family and staff experience and outcomes; future research is warranted to evaluate this. Development of high level of reliability interventions may further improve family presence and participation, particularly on high census days.