• Pediatric trauma and resuscitations: high-stakes, low-frequency, quality of care difficult to assess

• There are few data exploring the relationship of simulation performance to performance on real patients

• The validity of the assessment of simulated performance as a surrogate for clinical performance needs further investigation

Background

• To compare time to performance of interventions in simulated to real patient cases

• n= 22 real patient cases and 11 simulated cases• No difference in TTI between simulated and clinical cases for obtain SAMPLE history,

circulation assessment, airway assessment, cardiorespiratory/O2 monitors placed, verbalize vital signs, O2 administration, order consults/imaging

• Simulation faster for IV placement and estimating/obtaining patient weight• Insufficient data for check dextrose, apply defibrillator pads, discharge defibrillator,

initiate airway RSI, insert endotracheal tube

• Design: Prospective comparative study• Setting: Level 1 pediatric emergency department• Inclusion: Real (R): level 1 & 2 triage patients ≤18 y/o

Simulated (S): in-situ simulated patients both in and outside of Yale

• Collection period: June 2013-present• Subjects: Interdisciplinary pediatric emergency teams• Assessments: Time-to-intervention (TTI) = elapsed time from

patient arrival (t0) to performance of intervention• Interventions assessed: obtain SAMPLE history, circulation

assessment, airway assessment, cardiorespiratory/O2 monitors placed, verbalize vital signs, place IV, estimate/obtain patient weight, O2 administration, order consults/imaging, check dextrose, apply defibrillator pads, discharge defibrillator, initiate airway RSI, insert endotracheal tube

Lucas Butler, Anup Agarwal MBBS, Jaewon Jang PhDc, Marc Auerbach MDYale School of Medicine

Yale-New  Haven  Children’s  Hospital,  Pediatric  Emergency  Medicine  Department

Objective

Methods

ConclusionsAssessment Tool

Future Directions

Acknowledgements

• Performance in simulation is similar to real patient performance• TTI’s  measured  using  novel  iCODA checklist-stop watch application developed in

collaboration with Studiocode™

Limitations

Results

• Small sample size• Performance measured solely via TTI, without qualitative

assessment of performance• Confounding variables not measured—team size and

composition, case type

• These data support simulation performance assessment as surrogate for real patient performance

• Use of video review to improve data collection accuracy • Inclusion of qualitative data collection

• Funding Source: Vernon W. Lippard, M.D. Medical Student Research Fellowship, Yale University School of Medicine

• We would like to thank Mike Anzalone of Studiocode™  for  development  and aid with the iCODA application

• We would like to thank Dr. John Forrest & associates at the YSM Office of Student Research

• For questions, please contact lucas.butler@yale.edu