PC3113: Telesimulation as a Tool to Help Improve Pediatric Care at Community Hospitals

Background: Telesimulation has emerged as an innovative tool for virtual distance learning during the COVID-19 pandemic. Creative approaches that leverage video technology with simulation-based education principles provide a robust, engaging, and interactive experience for learners. This remote collaborative hands-on training has been especially helpful for our partner community hospitals. We detail how we use telesimulation to help our partners identify opportunities for improvement, close performance gaps, disseminate and implement learnings, and improve overall pediatric care.

Methods: We created a pediatric resuscitation telesimulation that incorporated national pediatric readiness survey elements as well as our statewide pediatric emergency care facility recognition program standards. We reached out to key stakeholders at each site to ensure that: (1) we could successfully teleconference into their space with adequate 2 way video and audio; (2) sites had a pediatric sized low fidelity mannequin; (3) participants could use their site’s actual equipment/supplies in real time; (4) sites were able to download a vital signs app onto a tablet device/simulated vitals monitor so we could remotely control the displayed vitals during the scenario; and (5) sites were able to gather a multidisciplinary hands on team representative of their normal resuscitation team plus remote observer learners. During the telesimulation, participants had to resuscitate a pediatric patient as they located and utilized their own pediatric specific equipment and supplies while recognizing nuances of pediatric care. Teams were also asked to find appropriate medications within their space and verbalize how they would calculate and administer the drugs. Our remotely facilitated debrief highlighted team successes, identified areas of needed growth, reviewed current evidence-based practice, and offered suggestions for improved care. Participants and key stakeholders were also surveyed about their telesimulation experience.

Results: We conducted 10 telesimulations using this format for a total of 139 participants. Participants included physicians, nurses, technicians, and respiratory therapists. 100% of our respondents found the telesimulation relevant and helpful and 100% would recommend the telesimulation to colleagues. Top learnings from these sessions included: key closed loop communication skills, identifying correct concentration and dose of epinephrine, using the bristojet adapter device, optimal delivery of bolus IV fluids in pediatrics, and proper use of the Broselow tape. As a result of the telesimulations, sites developed systems for routine equipment and supply checks as well as action plans to share learnings via huddles, department meetings, quality improvement initiatives, directed staff education events, and continued simulations.

Conclusion: Telesimulation has emerged as an interactive, thought-provoking way to learn as we navigate the pandemic. While it continues to be an evolving and advancing educational methodology, we have used it to successfully promote higher quality care in the community hospital setting. Further analysis is needed to assess its lasting impact.