Simulation to implement a novel system of care for pediatric critical airway obstruction.

OBJECTIVE

To implement a novel system of care for pediatric critical airway obstruction.

DESIGN

Retrospective, observational study of data gathered prospectively during high-fidelity simulations.

SETTING

Emergency department (ED) and operating rooms (ORs) of a pediatric referral center.

SUBJECTS: Health care provider simulation participants.

MAIN OUTCOME MEASURES: Time from ED attending physician request to arrival of an otolaryngologist, participant survey responses, identified latent safety threats, and simulated patient outcomes.

METHODS

Twelve high-fidelity simulations were conducted: 6 to identify problems with an existing system of care, and 6 to implement a novel system. The simulation scenarios involved a 4-year-old patient with severe respiratory distress after foreign-body aspiration managed solely in the ED or in the ED and OR, depending on stability.

RESULTS

There were 196 participants in 12 simulations. The mean (SD) time from ED attending physician request to otolaryngologist arrival was 7.8 (1.6) minutes for the existing system simulations and 5.0 (1.1) minutes for the novel system (P = .001). Latent safety threats identified in the simulations included a lack of specialized airway equipment in the ED. Death of the simulated patient occurred in the ED in 2 of 6 existing system simulations; specialized airway equipment was available for neither. For the novel system simulations, specialized airway equipment was available for all 6, no simulated patient deaths occurred.

CONCLUSIONS

High-fidelity simulation was an effective method to design and implement a novel system of care for pediatric critical airway obstruction. The novel system was associated with more rapid response times and elimination of simulated patient deaths.