title: Development of an instrument for a primary airway provider's performance with an ICU multidisciplinary team in pediatric respiratory failure using simulation.
abstract: OBJECTIVE
  To develop a scoring system that can assess the multidisciplinary management of respiratory failure in a pediatric ICU.
  
  
  METHODS
  In a single tertiary pediatric ICU we conducted a simulation-based evaluation in a patient care area auxiliary to the ICU. The subjects were pediatric  and emergency medicine residents, nurses, and respiratory therapists who work in the pediatric ICU. A multidisciplinary focus group with experienced providers in pediatric ICU airway management and patient safety specialists was formed. A task-based scoring instrument was developed to evaluate  a primary airway provider's performance through Healthcare Failure Mode and Effect Analysis. Reliability and validity of the instrument were evaluated using multidisciplinary simulation-based airway management training sessions. Each session was evaluated by 3 independent expert raters. A  global assessment of the team performance and the previous experience in training were used to evaluate the validity of the instrument.
  
  
  RESULTS
  The Just-in-Time Pediatric Airway Provider Performance Scale (JIT-PAPPS) version 3, with 34 task-based items (14 technical, 20 behavioral), was developed.  Eighty-five teams led by resident airway providers were evaluated by 3 raters. The intraclass correlation coefficient for raters was 0.64. The JIT-PAPPS score correlated well with the global rating scale (r = 0.71, P < .001). Mean total scores across the teams were positively associated  with resident previous training participation (β coefficient 7.1 ± 0.9, P < .001), suggesting good validity of the scale.
  
  
  CONCLUSIONS
  A task-based scoring instrument for a primary airway provider's performance with a multidisciplinary pediatric ICU team on simulated  pediatric respiratory failure was developed. Reliability and validity evaluation supports the developed scale.
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA. Nishisaki@email.chop.edu
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Donoghue
authors.forename: Shawn
authors.initials: S
authors.lastname: Colborn
authors.forename: Christine
authors.initials: C
authors.lastname: Watson
authors.forename: Andrew
authors.initials: A
authors.lastname: Meyer
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.forename: Ram
authors.initials: R
authors.lastname: Bishnoi
authors.forename: Roberta
authors.initials: R
authors.lastname: Hales
authors.forename: Larissa
authors.initials: L
authors.lastname: Hutchins
authors.forename: Mark A
authors.initials: MA
authors.lastname: Helfaer
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Brown
authors.forename: Ron M
authors.initials: RM
authors.lastname: Walls
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: John R
authors.initials: JR
authors.lastname: Boulet
mesh_terms: D058109:Airway Management; D002648:Child; D002983:Clinical Competence; D004496:Education, Continuing; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D010348:Patient Care Team / Q000458:organization & administration*; D011594:Psychometrics; D015203:Reproducibility of Results; D012131:Respiratory Insufficiency / Q000628:therapy*