title: Identifying incidents of suboptimal care during paediatric emergencies-an observational study utilising in situ and simulation centre scenarios.
abstract: OBJECTIVE
  Life threatening paediatric emergencies are relatively uncommon events. When they do occur staff caring for these children must have the ability to recognise the deterioration, evaluate and simultaneously treat these patients. The aim of this study was to identify suboptimal care during standardised simulated scenarios and to identify the potential causation factors.
  
  
  METHODS
  Participants were emergency department and operating theatre staff in Sydney, Australia. Incidents of suboptimal care were identified during scenarios and were analysed by thematic qualitative assessment methods. Potential causation factors were elicited both during and immediately after the scenarios and during facilitated debriefings. Causation factors were attributed to any of seven pre-defined categories.
  
  
  RESULTS
  Seventy-three simulations occurred over 9 month period in 2011. 270 doctors, 235 nurses and 11 students participated. 194 incidents of suboptimal care were observed and attributed to 325 causation factors. There were 76 knowledge deficits, 39 clinical skill deficits, 36 leadership problems, 84 communication failures, 20 poor resource utilisations, 23 preparation and planning failures and 47 incidents of a loss of situational awareness. Clinically important themes were: paediatric life support, drug choice and doses, advanced airway and ventilation, intravenous fluids and recognition of the deteriorating patient. Recurring incidents included the failure to recognise a cardiac arrest, inadequate fluid resuscitation and incorrect medication dose administration.
  
  
  CONCLUSIONS
  During standardised paediatric simulations multiple incidents of suboptimal care have been identified and multiple causation factors attributed to these. Educators should use this information to adapt current training programs to encompass these factors.
authors: Emergency Department, The Children's Hospital at Westmead, Sydney, Australia; Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, University Of Sydney, Australia. Electronic address: fenton.oleary@health.nsw.gov.au.
authors: Fenton
authors: F
authors: O'Leary
authors: Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, University Of Sydney, Australia.
authors: Kathryn
authors: K
authors: McGarvey
authors: Emergency Department, The Children's Hospital at Westmead, Sydney, Australia.
authors: Andrea
authors: A
authors: Christoff
authors: Emergency Department, The Children's Hospital at Westmead, Sydney, Australia.
authors: Jennifer
authors: J
authors: Major
authors: Emergency Department, The Children's Hospital at Westmead, Sydney, Australia.
authors: Francis
authors: F
authors: Lockie
authors: Emergency Department, The Children's Hospital at Westmead, Sydney, Australia.
authors: Gilad
authors: G
authors: Chayen
authors: Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, University Of Sydney, Australia; Sydney Clinical Skills and Simulation Centre, Sydney, Australia.
authors: John
authors: J
authors: Vassiliadis
authors: Anaesthetic Department, The Children's Hospital at Westmead, Sydney, Australia.
authors: Sally
authors: S
authors: Wharton
mesh_terms: D002648:Child; D004638:Emergency Treatment / Q000592:standards*; D006801:Humans; D016544:Patient Simulation; D011446:Prospective Studies; D011787:Quality of Health Care
keywords: Incidents of suboptimal care; Paediatric emergencies; Simulation