Effect of just-in-time simulation training on tracheal intubation procedure safety in the pediatric intensive care unit.
BACKGROUND
Tracheal intubation-associated events (TIAEs) are common (20%) and life threatening (4%) in pediatric intensive care units. Physician trainees are required to learn tracheal intubation during intensive care unit rotations. The authors hypothesized that "just-in-time" simulation-based intubation refresher training would improve resident participation, success, and decrease TIAEs.


METHODS
For 14 months, one of two on-call residents, nurses, and respiratory therapists received 20-min multidisciplinary simulation-based tracheal intubation training and 10-min resident skill refresher training at the beginning of their on-call period in addition to routine residency education. The rate of first attempt and overall success between refresher-trained and concurrent non-refresher-trained residents (controls) during the intervention phase was compared. The incidence of TIAEs between preintervention and intervention phase was also compared.


RESULTS
Four hundred one consecutive primary orotracheal intubations were evaluated: 220 preintervention and 181 intervention. During intervention phase, neither first-attempt success nor overall success rate differed between refresher-trained residents versus concurrent non-refresher-trained residents: 20 of 40 (50%) versus 15 of 24 (62.5%), P = 0.44 and 23 of 40 (57.5%) versus 18 of 24 (75.0%), P = 0.19, respectively. The resident's first attempt and overall success rate did not differ between preintervention and intervention phases. The incidence of TIAE during preintervention and intervention phases was similar: 22.0% preintervention versus 19.9% intervention, P = 0.62, whereas resident participation increased from 20.9% preintervention to 35.4% intervention, P = 0.002. Resident participation continued to be associated with TIAE even after adjusting for the phase and difficult airway condition: odds ratio 2.22 (95% CI 1.28-3.87, P = 0.005).


CONCLUSIONS
Brief just-in-time multidisciplinary simulation-based intubation refresher training did not improve the resident's first attempt or overall tracheal intubation success.
Nishisaki
Akira
A
Department of Anesthesiology and Critical Care Medicine, Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. nishisaki@email.chop.edu
Donoghue
Aaron J
AJ
Colborn
Shawn
S
Watson
Christine
C
Meyer
Andrew
A
Brown
Calvin A
CA
Helfaer
Mark A
MA
Walls
Ron M
RM
Nadkarni
Vinay M
VM
D000328:Adult; D002648:Child; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007396:Internship and Residency / Q000379:methods*; D007442:Intubation, Intratracheal / Q000592:standards*; D008297:Male; D008348:Manikins; D010372:Pediatrics / Q000193:education*; D015143:Philadelphia; D011446:Prospective Studies