title: Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams.
abstract: OBJECTIVE
  Resuscitation of pediatric cardiac patients involves unique and complex physiology, requiring multidisciplinary collaboration and teamwork. To optimize team performance, we created a multidisciplinary Crisis Resource Management training course that addressed both teamwork and technical skill needs for the pediatric cardiac intensive care unit. We sought to determine whether participation improved caregiver comfort and confidence levels regarding future resuscitation events.
  
  
  METHODS
  We developed a simulation-based, in situ Crisis Resource Management curriculum using pediatric cardiac intensive care unit scenarios and unit-specific resuscitation equipment, including an extracorporeal membrane oxygenation circuit. Participants replicated the composition of a clinical team. Extensive video-based debriefing followed each scenario, focusing on teamwork principles and technical resuscitation skills. Pre- and postparticipation questionnaires were used to determine the effects on participants' comfort and confidence regarding participation in future resuscitations.
  
  
  RESULTS
  A total of 182 providers (127 nurses, 50 physicians, 2 respiratory therapists, 3 nurse practitioners) participated in the course. All participants scored the usefulness of the program and scenarios as 4 of 5 or higher (5 = most useful). There was significant improvement in participants' perceived ability to function as a code team member and confidence in a code (P < .001). Participants reported they were significantly more likely to raise concerns about inappropriate management to the code leader (P < .001).
  
  
  CONCLUSIONS
  We developed a Crisis Resource Management training program in a pediatric cardiac intensive care unit to teach technical resuscitation skills and improve team function. Participants found the experience useful and reported improved ability to function in a code. Further work is needed to determine whether participation in the Crisis Resource Management program objectively improves team function during real resuscitations.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Boston, Mass 02115, USA. catherine.allan@cardio.chboston.org
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Allan
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Dorothy
authors.initials: D
authors.lastname: Beke
authors.forename: Annette
authors.initials: A
authors.lastname: Imprescia
authors.forename: Liana J
authors.initials: LJ
authors.lastname: Kappus
authors.forename: Alexander
authors.initials: A
authors.lastname: Garden
authors.forename: Gavin
authors.initials: G
authors.lastname: Hayes
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
authors.forename: Peter H
authors.initials: PH
authors.lastname: Weinstock
mesh_terms: D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D001291:Attitude of Health Personnel; D001900:Boston; D016507:Cardiology Service, Hospital / Q000458:organization & administration; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D004502:Education, Medical, Continuing / Q000458:organization & administration; D006126:Group Processes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration; D008348:Manikins; D010348:Patient Care Team / Q000458:organization & administration; D016544:Patient Simulation; D016730:Program Development; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D014741:Video Recording