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.