Development of an instrument for a primary airway provider's performance with an ICU multidisciplinary team in pediatric respiratory failure using simulation.

Nishisaki A, Donoghue AJ, Colborn S, Watson C, Meyer A, Niles D, Bishnoi R, Hales R, Hutchins L, Helfaer MA, Brown CA 3rd, Walls RM, Nadkarni VM, Boulet JR.

Source

Children's Hospital of Philadelphia, Philadelphia, PA, USA. Nishisaki@email.chop.edu

Abstract

OBJECTIVE:

To develop a scoring system that can assess the multidisciplinary management of respiratory failure in a pediatric ICU.

METHODS:

In a single tertiary pediatric ICU we conducted a simulation-based evaluation in a patient care area auxiliary to the ICU. The subjects were pediatric and emergency medicine residents, nurses, and respiratory therapists who work in the pediatric ICU. A multidisciplinary focus group with experienced providers in pediatric ICU airway management and patient safety specialists was formed. A task-based scoring instrument was developed to evaluate a primary airway provider's performance through Healthcare Failure Mode and Effect Analysis. Reliability and validity of the instrument were evaluated using multidisciplinary simulation-based airway management training sessions. Each session was evaluated by 3 independent expert raters. A global assessment of the team performance and the previous experience in training were used to evaluate the validity of the instrument.

RESULTS:

The Just-in-Time Pediatric Airway Provider Performance Scale (JIT-PAPPS) version 3, with 34 task-based items (14 technical, 20 behavioral), was developed. Eighty-five teams led by resident airway providers were evaluated by 3 raters. The intraclass correlation coefficient for raters was 0.64. The JIT-PAPPS score correlated well with the global rating scale (r = 0.71, P < .001). Mean total scores across the teams were positively associated with resident previous training participation (β coefficient 7.1 ± 0.9, P < .001), suggesting good validity of the scale.

CONCLUSIONS:

A task-based scoring instrument for a primary airway provider's performance with a multidisciplinary pediatric ICU team on simulated pediatric respiratory failure was developed. Reliability and validity evaluation supports the developed scale.