A randomized, controlled trial of in situ pediatric advanced life support recertification ("pediatric advanced life support reconstructed") compared with standard pediatric advanced life support recertification for ICU frontline providers*.
OBJECTIVE
Recent evidence shows poor retention of Pediatric Advanced Life Support provider skills. Frequent refresher training and in situ simulation are promising interventions. We developed a "Pediatric Advanced Life Support-reconstructed" recertification course by deconstructing the training into six 30-minute in situ simulation scenario sessions delivered over 6 months. We hypothesized that in situ Pediatric Advanced Life Support-reconstructed implementation is feasible and as effective as standard Pediatric Advanced Life Support recertification.


METHODS
A prospective randomized, single-blinded trial.


METHODS
Single-center, large, tertiary PICU in a university-affiliated children's hospital.


METHODS
Nurses and respiratory therapists in PICU.


METHODS
Simulation-based modular Pediatric Advanced Life Support recertification training.


RESULTS
Simulation-based pre- and postassessment sessions were conducted to evaluate participants' performance. Video-recorded sessions were rated by trained raters blinded to allocation. The primary outcome was skill performance measured by a validated Clinical Performance Tool, and secondary outcome was behavioral performance measured by a Behavioral Assessment Tool. A mixed-effect model was used to account for baseline differences. Forty participants were prospectively randomized to Pediatric Advanced Life Support reconstructed versus standard Pediatric Advanced Life Support with no significant difference in demographics. Clinical Performance Tool score was similar at baseline in both groups and improved after Pediatric Advanced Life Support reconstructed (pre, 16.3 ± 4.1 vs post, 22.4 ± 3.9; p < 0.001), but not after standard Pediatric Advanced Life Support (pre, 14.3 ± 4.7 vs post, 14.9 ± 4.4; p =0.59). Improvement of Clinical Performance Tool was significantly higher in Pediatric Advanced Life Support reconstructed compared with standard Pediatric Advanced Life Support (p = 0.006). Behavioral Assessment Tool improved in both groups: Pediatric Advanced Life Support reconstructed (pre, 33.3 ± 4.5 vs post, 35.9 ± 5.0; p = 0.008) and standard Pediatric Advanced Life Support (pre, 30.5 ± 4.7 vs post, 33.6 ± 4.9; p = 0.02), with no significant difference of improvement between both groups (p = 0.49).


CONCLUSIONS
For PICU-based nurses and respiratory therapists, simulation-based "Pediatric Advanced Life Support-reconstructed" in situ training is feasible and more effective than standard Pediatric Advanced Life Support recertification training for skill performance. Both Pediatric Advanced Life Support recertification training courses improved behavioral performance.
1Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Tokyo Metropolitan Children's Medical Centre, Tokyo, Japan. 3Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, PA. 4Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, PA. 5Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 6Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 7Division of Neonatal and Perinatal Medicine, Oregon Health and Science University, Portland, OR.
Hiroshi
H
Kurosawa
Takanari
T
Ikeyama
Patricia
P
Achuff
Madeline
M
Perkel
Christine
C
Watson
Annemarie
A
Monachino
Daphne
D
Remy
Ellen
E
Deutsch
Newton
N
Buchanan
Jodee
J
Anderson
Robert A
RA
Berg
Vinay M
VM
Nadkarni
Akira
A
Nishisaki
D022561:Advanced Cardiac Life Support / Q000193:education*; D016887:Cardiopulmonary Resuscitation / Q000193:education; D002568:Certification; D002983:Clinical Competence; D003198:Computer Simulation; D004496:Education, Continuing / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D015278:Intensive Care Units, Pediatric; D008020:Life Support Care / Q000379:methods; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D014481:United States; D014741:Video Recording