O0431 Oct.5: 1:31pm - Assessment and improvement of COVID-19 unit and provider readiness through medical simulation in a Level III pediatric intensive care unit

Background
The COVID-19 pandemic represents an unprecedented global crisis that has health care workers (HCW) facing unique challenges. The estimated infection risk of HCW treating COVID-19 patients has been demonstrated to be significant. In order to assure patient and provider safety with effective management, optimal preparedness is key.
The aim of this project was to assess and optimize HCW and unit readiness for high risk procedures in COVID-19 patients with appropriate use of personal protective equipment (PPE).

Methods
Two high fidelity simulation scenarios targeting high risk COVID-19 procedures (planned intubation, acute decompensation/code event) were designed and conducted within a 34-bed-level III Pediatric Intensive Care Unit (PICU). Multidisciplinary participation was targeted.
A 6-question survey using a 5-point Likert scale (1=strongly disagree, 5=strongly agree) was designed to collect information regarding perceived level of comfort, preparedness, and understanding of proper use of PPE. It was distributed at three different time points - pre simulation, post simulation, and post actual patient events in the PICU.
Statistical analysis was performed using two-sided independent t-test and One Way ANOVA. P-values ≤0.05 were considered significant.

Results
A total of 55 surveys were received. Nursing was the most represented staff group (56.4%), followed by respiratory technicians, advanced practice providers, residents, PICU attendings/fellows, anesthesia attendings and others (10.9%, 9.1%, 9.1%, 7.3%, 3.6% and 3.6%, respectively). Overall survey results are displayed in Table 1.
Results of statistical analyses are documented in Table 2. The uptrending scores between the pre and post simulation survey are reflective of increasing comfort and expertise level. Statistical significance was demonstrated for PPE handling, intubation dynamics and code dynamics (p <0.001, =0.001, and =0.001, respectively).
Based on actual patient experience, those who had participated in COVID-19 simulations demonstrated higher provider comfort level (p=0.048).
In addition, continued improvement from pre to post simulation to post actual patient event was seen in simulation participants in 3 of 6 assessed items (comfort level, general intubation aspects, and PPE handling). ANOVA demonstrated a significant effect of the different time points on 5 out of 6 survey items for those who participated in COVID-19 simulations.

Conclusion
In unprecedented circumstances such as the COVID-19 pandemic, medical simulation provides a safe and efficient tool to improve provider and system preparedness. Our results emphasize its effectiveness to increase general provider comfort level and PPE use in high risk situations such as intubation and code dynamics.