Project CAPE: a high-fidelity, in situ simulation program to increase Critical Access Hospital Emergency Department provider comfort with seriously ill pediatric patients.
OBJECTIVE
Variation exists between the qualities of emergency department (ED) care provided to urban versus rural pediatric patients. We implemented a pediatric simulation program in the Critical Access Hospital (CAH) ED setting and evaluated whether this training would increase provider comfort with seriously ill children.


METHODS
Five CAH hospitals conducted 6 scenarios for 12 months. Baseline surveys assessed ED staff exposure to and comfort with children. Surveys were repeated after 6 and 12 months. Respondents' answers were matched longitudinally. Changes in responses over time were analyzed using paired t tests for continuous variables. Changes in frequencies and percentages of categorical variables over time were analyzed using χ test. Scenario participants completed an additional survey at the end of each simulation.


RESULTS
The baseline survey was completed by 104 of 150 eligible participants, giving a 71% response rate. Fifty-eight percent completed at least 1 additional survey. On survey 1, mean provider comfort score for procedures was 69 (0-100 point scale). Scores increased 6 points from surveys 1 to 2 and a total of 6.5 points from surveys 1 to 3 (P < 0.05).One hundred fifty postscenario surveys were completed. Of the providers, 83.7% believed that scenario participation increased their comfort with children. One hundred percent of the providers in month 12 felt that they would benefit from additional scenarios.


CONCLUSIONS
An in situ pediatric simulation program can be implemented effectively in CAH EDs and results in increased comfort with pediatric patients. Such a program could be used as the core feature of a CAH education program aimed at improving the quality of pediatric emergency services provided at these safety net institutions.
From the *Division of Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; Departments of †Pediatrics, and ‡Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill; and §School of Medicine, Duke University, Durham, NC.
Jessica H
JH
Katznelson
William A
WA
Mills
C Scott
CS
Forsythe
Sophie
S
Shaikh
Sue
S
Tolleson-Rinehart
D002648:Child; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007223:Infant; D008297:Male; D009657:North Carolina; D016544:Patient Simulation; D010372:Pediatrics / Q000193:education*; D011795:Surveys and Questionnaires