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An Assessment of Illinois Hospitals' Emergency Department (ED) Pediatric Mock Code/Simulation Practices and Needs

Friday, October 19, 2012
Room 272-273 (Morial Convention Center)
Parul B. Patel, MD, MPH1, Evelyn Lyons, RN, MPH2, Christine Kennelly, RN, MS3, Daniel R. Leonard, MS3, Laura Prestidge, RN, BSN, MPH3, Kathryn Janies, BA3 and Susan Fuchs, MD1, (1)Pediatric Emergency Department, Children's Memorial Hospital/ Feinberg School of Medicine Northwestern University, Chicago, IL, (2)Division of EMS & Highway Safety, Illinois Department of Public Health, Maywood, IL, (3)Emergency Medical Services, Loyola University Health System, Maywood, IL


Exposure to critically ill children is rare among emergency care providers at non-children’s hospitals.  Thus, a level of discomfort exists when managing a seriously ill or injured child.  Mock code/simulation training has been proven to be effective in improving confidence, team work/performance and patient safety in emergent situations. The Illinois Emergency Medical Services for Children (IL EMSC) program strives to ensure hospitals are better prepared for pediatric emergencies. A needs assessment was conducted to better understand current pediatric mock code/simulation practices in order to direct the focus of future education.


A survey was developed with questions related to hospital characteristics, IL EMSC Facility Recognition program level [i.e., Emergency Departments Approved for Pediatrics (EDAP)], current practices and perceived needs, and barriers to develop a Pediatric Mock Code/Simulation (PMC/Sim) program. This online survey was provided to hospitals in Illinois (including a few hospitals outside of IL along the state border). Responses were analyzed using IBM® SPSS®.


Response rate was 74% (89 surveys returned from 120 facilities).  The facilities were 32% rural, 40% suburban, and 28% urban. Median pediatric ED visits were 6 – 7,000/year. 63% conducted PMC/Sims in the ED. Frequency of the PMC/Sims ranged from 1/year (32%) to >10/year (3%) with median 2/year. Barriers included time (63%), cost (38%), unclear how to set up program (38%), lack of interest (35%), and no one to coordinate (19%). Equipment used during PMC/Sims included: infant/child manikin (41%), infant/child manikin with arrhythmia simulator (12%), high fidelity manikin (8%), paper cut-out figure (1%), and other (1%). Presence of any of these types of equipment was related to PMC/Sims conducted (94% of those having equipment vs. 19% of those not having equipment, p <0.05). Funding was also related to PMC/Sims conducted (93% of those having funding conducted codes vs. 56% of those that did not, p <0.05). Unfortunately, 83% reported no funding available to conduct PMC/Sims. Larger facilities (>7K pediatric visits/year) were significantly more likely (p<0.05) to conduct mock codes than smaller facilities (<7K pediatric visits/year); however, no significant difference was found in urban and suburban vs. rural facilities.  Based on a small sample, recognized facilities were more likely to conduct codes than non-recognized facilities (p<0.05); this difference was also significant in smaller facilities that are recognized.  Of all respondents, 70% were “very interested” and 23% were “moderately interested” in additional onsite education related to PMC/Sim training. 


The majority of the surveyed facilities conduct PMC/Sims infrequently. Barriers include time, cost, funding, equipment, lack of knowledge and coordinators for program. Despite these barriers, survey respondents showed a strong interest in additional onsite education for PMC/Sim training.