PC3076: Improving Pediatric Critical Care Fellow Management and Communication in Transfers of Critically Ill Patients Through the Use of Referral Call Simulation Scenarios

Background: Referral and transportation of critically ill children is an important and growing aspect of pediatric critical care medicine (PCCM). Both knowledge of transport medicine physiology and clear communication with referring providers are keys to safe transportation of patients to tertiary facilities. Nationally, PCCM fellows often serve as transport medical control (TMC); however, established training curricula are lacking. At our institution, PCCM fellows serve as TMC for all transfers to the pediatric intensive care unit (PICU). Current training includes didactics and informal education while on clinical service. We sought to improve fellow management and communication in referral calls regarding the transfer of critically ill children through referral call simulations.

Methods: We developed two simulation scenarios, one for the transfer of a patient with severe diabetic ketoacidosis and another for a patient with cardiac arrest of undefined etiology. PCCM fellows individually ran through each scenario. Fellows communicated over the phone with a confederate acting as the referring provider while they entered clinical data into the patient record using the Epic® Playground electronic health record platform. A voice-changer was used to remove familiarity with the confederate. Investigators with simulation expertise debriefed fellows after each scenario. Fellows completed surveys before and after the simulation scenarios to assess their comfort with serving as TMC.

Results: All fellows in our PCCM fellowship program (6) participated in each simulation scenario. Prior to conducting the simulation scenarios, third-year PCCM fellows reported greater confidence in their ability to obtain necessary information regarding the patient’s status and communicate effectively with the referring provider than first- or second-year fellows. After running the simulations, all fellows generally reported increased confidence in their abilities to communicate clearly with referring providers and gather information necessary for the care of patients being transferred to the PICU.

Conclusion: Simulation of referral calls to the PICU is an effective method to improve PCCM fellow confidence in gathering relevant patient data and communicating with referring providers. Our data is limited by the small number of participants. Fellows also had previous experience serving as TMC. Future simulations will include new PCCM fellows without prior experience as TMC and will incorporate evaluation of communication in recorded transport calls before and after implementation of recurring referral call simulation education.