Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool.
BACKGROUND
Though rare, allergic reactions occur as a result of administration of low osmolality nonionic iodinated contrast material to pediatric patients. Currently available resuscitation aids are inadequate in guiding radiologists' initial management of such reactions.


OBJECTIVE
To compare radiology resident competency with and without a computer-based interactive resuscitation tool in the management of life-threatening events in pediatric patients.


METHODS
The study was approved by the IRB. Radiology residents (n = 19; 14 male, 5 female; 19 certified in basic life support/advanced cardiac life support; 1 certified in pediatric advanced life support) were videotaped during two simulated 5-min anaphylaxis scenarios involving 18-month-old and 8-year-old mannequins (order randomized). No advance warning was given. In half of the scenarios, a computer-based interactive resuscitation tool with a response-driven decision tree was available to residents (order randomized). Competency measures included: calling a code, administering oxygen and epinephrine, and correctly dosing epinephrine.


RESULTS
Residents performed significantly more essential interventions with the computer-based resuscitation tool than without (72/76 vs. 49/76, P < 0.001). Significantly more residents appropriately dosed epinephrine with the tool than without (17/19 vs. 1/19; P < 0.001). More residents called a code with the tool than without (17/19 vs. 14/19; P = 0.08). A learning effect was present: average times to call a code, request oxygen, and administer epinephrine were shorter in the second scenario (129 vs. 93 s, P = 0.24; 52 vs. 30 s, P < 0.001; 152 vs. 82 s, P = 0.025, respectively). All the trainees found the resuscitation tool helpful and potentially useful in a true pediatric emergency.


CONCLUSIONS
A computer-based interactive resuscitation tool significantly improved resident performance in managing pediatric emergencies in the radiology department.
Division of Pediatric Radiology, Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA. lerne003@mc.duke.edu
Catherine
C
Lerner
Ana M
AM
Gaca
Donald P
DP
Frush
Sue
S
Hohenhaus
Anjanette
A
Ancarana
Terry A
TA
Seelinger
Karen
K
Frush
D002648:Child; D003194:Computer-Assisted Instruction / Q000295:instrumentation* / Q000379:methods*; D004521:Educational Measurement / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008348:Manikins; D010372:Pediatrics / Q000295:instrumentation / Q000379:methods*; D011361:Professional Competence; D012151:Resuscitation / Q000193:education* / Q000295:instrumentation / Q000379:methods; D017751:Safety Management / Q000379:methods*; D014481:United States