Quick Thinking: How the Pediatric Intensive Care Unit Adapted Simulation for the Pandemic

Purpose/Objectives: The creation of a biocontainment unit (BCU) team was established for the preparation of care for patients with highly infectious diseases in 2014. When the COVID-19 pandemic surfaced, the nursing and physician leadership from the BCU and the MICU designed simulations around the safe provision of care during aerosol generating procedures (AGPs) in emergent situations. These low fidelity simulation sessions helped to prepare clinicians based on real life scenarios when intubating and coding a patient with COVID-19.
The purpose of this was to successfully prepare PICU staff to safely care for patients receiving AGPs during an emergency through quick 30-minute simulations in situ. The goal of these simulations was to practice limiting the number of people in the patient room to minimize exposure risk to staff, while still maintaining high-quality communication among all team members during emergency situations.

Design/Methods: The simulation sessions occurred on the PICU in an empty bed space with ICU team members during their shift. Simulation offerings occurred during the day and night shifts. For each simulation session, feedback from the multidisciplinary team allowed for iterative changes to be made to the procedural checklist used in everyday practice for intubation. These sessions also identified multiple communication barriers from occurring both inside and outside of the patient room. These communication issues were addressed through real time debriefing and by trialing creative, thoughtful solutions during subsequent simulation sessions such as using wireless headsets and scannable QR codes to zoom calls. A survey sent by the Survey Monkey™ software was given to all participants to determine the effectiveness of these simulations and changes that needed to take place in the future.

Results: Survey responses were received from 21 of 42 clinicians who attended the simulations. 90% of clinicians indicated they felt comfortable with the intubation checklist modifications with regard to intubation being considered an AGP. The clinicians all indicated they were comfortable with the new techniques being taught to them in the scenarios. 90% of clinicians understood their roles in the emergency situation and felt they were more prepared for critical care situations involving patients on or receiving AGPs.

Conclusion/Discussion: In the event, that the PICU is faced with the inability to utilize simulation spaces in the future, there is an ability now to offer simulation in situ on the PICU itself. The use of Zoom calls to an iPad into the room of a critically ill patient on airborne precautions has been extremely useful in maintaining communication with the rest of the PICU team outside of the room, while minimizing the clinicians required in the room.