Research @ PEM January 2017 · PEM in the upcoming years: 1) INK - intranasal ketamine for fracture...
Transcript of Research @ PEM January 2017 · PEM in the upcoming years: 1) INK - intranasal ketamine for fracture...
M O N T H L Y N E W S L E T T E R F R O M T H E D E P A R T M E N T O F P E D I A T R I C E M E R G E N C Y M E D I C I N E
PEM
PEDIATRIC PREPAREDNESSSimulation-based training programs to prepare physicians
V O L U M E 1 • I S S U E 7 • J A N U A R Y 2 0 1 8
research@
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Pediatric Preparedness
Events and Updates
Recent presentations
Study updates
Volunteer of the Month
Contacts
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02References: Katznelson, Jessica H., et al. “Improving Pediatric Preparedness in Critical Access Hospital Emergency Departments.” Pediatric Emergency Care, vol. 34, no. 1, 2018, pp. 17–20., doi:10.1097/pec.0000000000001366.
While McMaster Children’s Hospital is fortunate in having an ED dedicated to the pediatric population, with house staff trained in pediatric emergency medicine – this is not the case in rural areas. Rural areas may not have the resources, whether work force or finances, to support emergency services, let alone pediatric emergency services for their respective communities. This dire need can be further exacerbated by travel time needed to reach a tertiary centre that can provide adequate care. So, what can be done to provide access, education, and services to prepare physicians who work in rural environments and to improve pediatric health outcomes?
The journal of Pediatric Emergency Care published an article (https://goo.gl/ivVgrt) to assess if a simulation program in Critical Access Hospitals (CAH) can prepare physicians for pediatric emergencies. CAH are institutions in the US which rarely have pediatric emergencies and/or physicians trained to manage pediatric emergencies. They are located more than 35 miles (~56 km) from the nearest hospital. Simulations have shown to improve team performance, increase confidence in one’s ability and provide exposure to situations that aren’t typically encountered.
The study utilized an in-situ 12-month pediatric simulation program at 5 CAHs. A 35-item checklist inquiring about resuscitation methods was used to evaluation team performance. Checklist items included: identification of team leader, airway opening, appropriate CPR, focused history, appropriate fluid resuscitation, debriefing, amongst others. The 6 scenarios included: Airway Obstruction (croup), Respiratory Distress (asthma), Shock (cardiogenic), Cardiac Arrest, Status Epilepticus and Altered Mental Status (Diabetic Ketoacidosis). The Kruskal-Wallis rank test was used to assess for differences in average scores among the CAH institutions.
The results of the test showed no difference in average scores among institutions (p = 0.90). The scores also showed a significant downward trend over time, with a scenario-to-scenario decrease (p < 0.01). In other words, checklist scores improved over time both within and across Institutions (more “yes” answers to successfully completed recommended interventions). All of the providers surveyed in the last month stated they would benefit from ongoing scenarios. Four of the 5 participating CAHs have continued to run regularly scheduled pediatric simulations in the year after completion of the study, with the fifth hospital in the process of restarting.
While the study was limited to only 5 CAHs in North Carolina and simulations were limited to ages 2-6 years, it did show that simulations (and maintenance of them) can be beneficial in training physicians. At McMaster, a study is underway to assess pediatric emergency preparedness in the Canadian context. A national survey has been mailed out to family physicians and pediatricians to assess preparedness in an office-based setting. The survey seeks to find out if: physicians are aware of CPS guidelines, have essential first aid training, have adequate supplies in their office, amongst others. In either case, what is important is that access to education and resources are vital in the management of urgent pediatric cases. - Dr. April Kam ([email protected])
Preparing for Pediatric Emergencies
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Events & UpdatesPediatric Emergency Research
Canada (PERC) 2018Delegates from all Canadian medical institutions were present at Mt. Tremblant from January 28th to February 1st, 2018. The Pediatric Emergency Research Canada (otherwise known as PERC) is a "well-established network of health care researchers at 15 Canadian Children’s Hospitals that is dedicated to improving care in pediatric emergency medicine through multi-centre research. PERC has a track recording of producing results that matter."
Guest speakers included: 1) Dr. PJ Subbarao - The CHILD study - a multicenter Canadian birth cohort study 2) Dr. Rich Ruddy - Network and single center research - 'New' models to consider
Representing McMaster at PERC included: Dr. Anthony Crocco, Dr. Mohamed Eltorki, Dr. April Kam, Dr. Jeffrey Pernica, Dr. Melissa Parker and Mohammed Hassan-Ali. Study updates and progress reports from SAFER and SQUEEZE trials were presented at the conference.
Several interesting research topics/studies were presented at this year's conference, many of which, will involve McMaster PEM in the upcoming years: 1) INK - intranasal ketamine for fracture reduction 2) Family Needs survey 3) PRIMED - biomarkers for appendicitis 4) Cross sectional assessment of PEM MH management and outcome
Next year's conference will be held in Banff, Alberta. For more information, visit: https://perc-canada.ca/
Events & Updates
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D e p a r t m e n t o f P e d i a t r i c s C h i l d H e a l t h R e s e a r c h D a y 2 0 1 8
Join us for the 10th annual Child Health Research Day on Wednesday, March 28th, as we celebrate the
contributions to child health research by undergraduate students, medical students, graduate
students, pediatric residents, post-doctoral and clinical fellows, new Faculty and research staff working
in Pediatrics!
Abstracts are now being accepted via the form below; the deadline for submission is February 26,
2018.
C l i c k h e r e f o r m o r e i n f o r m a t i o n a n d o n l i n e r e g i s t r a t i o n
C I H R P R O J E C T G R A N T C O M P E T I T I O N - S P R I N G 2 0 1 8
Pediatrics Internal Deadline: February 16
HRS Internal Deadline: February 26 by 4 pm
CIHR Application Deadline: March 6 by 4 pm
Internal Review timelines for the Spring 2018 Project Grant competition are now available for both HRS
and the Department of Pediatrics. Full information for this funding opportunity is available on the CIHR
website.
Please let Lindsay Akrong know if you plan to apply
H H S H I G H S C H O O L H E A L T H R E S E A R C H B U R S A R Y Deadline for mentor applications: March 30, 2018
In its 15th year, this program links mentors with skilled summer students (screened and funded by
HHS) to work on research projects. For the students, this is an amazing opportunity to gain "hands-
on" experience to further enhance skill sets and gain valuable insight of career choices that will help
them with selecting post-secondary studies. Mentors benefit from having these very capable and
bright young adults joing their programs from July 3, 2018 to August 17, 2018.
C l i c k h e r e f o r m o r e i n f o r m a t i o n
Events & Updates
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F A C U L T Y O F H E A L T H S C I E N C E S E D U C A T I O N I N N O V A T I O N F U N D
Purpose To encourage and provide support for the development and evaluation of novel and innovative approaches to health sciences
education in the Faculty of Health Sciences.
Eligibility All members of the faculty of FHS are eligible for funding support. Funding cannot be used to supplement another partly
funded project. All those awarded funding must be willing to present their research at the Geoffrey R Norman FHS Education Research
Day in June. Priority will be given to projects that address competency-based education, simulation-based education and innovative
pedagogy and projects where theory is used/developed to inform practice. The activity of the project should be focused on McMaster
Faculty of Health Sciences.
Application Process Applicants are required to submit:
1) An abridged CV (max. 3 pages, focussing on previous research and educational scholarship)
2) A project summary - 3 pages maximum, single spaced, plus references, outlining:-
a. Proposed study question/objectives
b. Proposed method of analysis
c. Expected project outcome
d. Strategy for disseminating outcome findings
e. Potential education impact of the study
f. Potential of the research for commercialization, if applicable
3) Budget The following expenses are ineligible:-
a. Salary support for P.I. or other faculty members
b. Computers and other equipment unless integral to the study e.g. voice recording equipment
c. Infrastructure expenses that are presently supported elsewhere (e.g. telephone, administrative assistant)
No university overhead will be charged. Open Access journal publications costs will be allowed.
4) Adjudication
The adjudication process will be administered by the office of the Associate Dean, Health Professional Education who will chair a
selection committee of senior faculty. Preference will be given to projects that address the priority areas identified in the Eligibility
section above and that incorporate a design that uses theory to inform practice or uses practice to develop theory.
Award Amount Funding will be awarded to one or more applicants annually for up to two years of funding support to a maximum of
$50,000 per project, spread over the two years; funding for the second year is contingent on the submission of a satisfactory interim
report to the selection committee prior to the end of the first year of funding. A final report shall be submitted upon completion of the
project. The selection committee reserves the right to not fund any projects in any given year. Award winners will be announced at the
Geoffrey R. Norman FHS Education Research Day on June 6, 2018.
Application Details
1) Deadline for application April 13, 2018 at midnight.
2) Submit as 1 pdf document with the P.I.’s name and a short version of the title as the document’s name.
3) Submit to the office of the Associate Dean, Health Professional Education c/o [email protected].
Recent Presentations
H A V E A R E C E N T P U B L I C A T I O N / P R E S E N T A T I O N T H A T Y O U W A N T T O S H O W C A S E H E R E ? S E E C O N T A C T S S E C T I O N T O S U B M I T .
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D r . Q u a n g N g o
D r . F a h a d M a s u d
Poster title: Rapid Cycle Deliberate Design in Optimizing Clinical Spaces
Poster presented at: International Meeting for Simulation in Healthcare (IMSH 2018) in Los Angeles, Jan. 13-17, 2018.
Introduction/Background: In situ simulation has been used as a tool for the assessment of clinical spaces. In a
pediatric tertiary care center, the use of in situ simulation was central in the design of the emergency tracheostomy care
setup in a newly designed complex care ward. A key challenge in this project revolved around how to most efficiently
identify patient safety and design issues, incorporate feedback and evaluate resulting changes. The concept of “rapid
cycle deliberate practice” (RCDP) has been proposed as an educational framework by Hunt et al wherein masterly
learning is achieved through cycles of deliberate practice and real time directed feedback with an expert. We proposed
the use of RCDP as a framework for quality improvement and clinical space evaluation wherein identified issues in
patient safety and design could be quickly identified, environments modified and changes evaluated all within a short
period of time.
Methods: In preparation for the cycles, an inter-professional group of key stakeholders met to design the “ideal” first
iteration of the patient care room with respect to tracheostomy care. Three common emergency tracheostomy care
scenarios (accidental de-cannulation, obstruction and difficult tracheostomy change) were then developed to identify
patient safety and design issues and test subsequent changes. 2 consecutive sessions were then organized in situ using
the above 3 scenarios during regular working hours. Participants included front line health care staff as well as parents.
During each simulation, a team of observers recorded feedback using a tool designed for the exercise. Debriefing of the
scenario was done using a “plus/delta” approach and focussed specifically on systems issues. The clinical space was then
adjusted accordingly and the subsequent scenario run to test the incorporated changes. Validation of the new changes
would be measured as decreasing numbers of changes in subsequent simulations.
Results: Over 5 simulations, issues were recorded using the observer tool into 4 categories: Structure, Workflow, Patient
Safety, and Education. Overall, 41 issues were identified throughout the scenarios with 13 classified as impacting patient
safety requiring immediate correction. Through the scenarios, 19 changes were made, with each subsequent scenario
having a decrease in both the number of issues identified, and number of changes required. Controlling for
infrastructure related issues, 0 issues were identified by the 5th simulation. Video analysis revealed a decrease in time
(seconds) to first responder, first suction, locating bag mask, locating fitted mask, and total time searching for equipment
with each implemented change and subsequent simulation session.
Conclusion: We have adapted an RCDP framework to efficiently achieve the ideal setup for emergency tracheostomy
care in our patient care environment. Using this method, we were able to effectively identify design and patient safety
issues and implement changes that solved them in a timely fashion. Traditional quality improvement methods would be
more difficult to implement given the high stakes but low frequency of pediatric emergencies. To our knowledge, the use
of in situ simulation used in this manner has not been reported before, and could be scaled and adapted to many
different clinical environments dealing with the same types of events. We conclude that RCDP simulation can be applied
to space design and quality improvement in an efficient and cost effective manner.
Research so far...Video AOM
MISSED (in January)
ENROLLED (in January)
84 14PATIENTS
ENROLLED
TOTAL
62Between 6 - 59 months of age
Primary diagnosis of non-severe AOM
Eligible for watchful waiting prior to filling
antibiotic prescription
PAGE #4545 if your patient:
NEW AOM TRACKING FORM!Please fill out the PINK REFUSAL TO
PARTICIPATE form in Acute or Ambulatory
Required information includes: Patient label,
Physician name and date, and CHECKMARK if
if the patient is INELIGIBLE, REFUSED or
MISSED
WE NOW HAVEWEEKEND RESEARCH
SUPPORT!
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TOTAL
78
45MISSED
(in January)ENROLLED (in January)
3PATIENTS
ENROLLED
SAFER
PAGE #4545 if your patient:Between 6 months - 10 years presenting with CAP:
Fever (>37.5 C axillary, >37.7 C oral, >38 rectal) recorded
in ED or home in the 48h prior to presentation
Any one of: tachypnea on exam, cough on exam/history,
increased work of breathing on exam, auscultatory
findings consistent with pneumonia
Infiltrates on CXR consistent with bacterial CAP as judged
by ED physician
Attending ED physician diagnoses the child with primary
CAP
Please fill out the MANILA REFUSAL TO
PARTICIPATE form in Acute or Ambulatory
Required information includes: Patient label,
Physician name and date, and CHECKMARK if if
the patient is INELIGIBLE, REFUSED or MISSED
NEW SAFER TRACKING FORM!WE NOW HAVE WEEKEND RESEARCH
SUPPORT!
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Eligible patient?
No
Track
Yes
Ask patient:
"Would they
like to hear
about study?"
No
Yes
RA Available?
No
Consent to
Approach?
Page #4545 &
Give RX to
study team
RA will notify MD if
patient enrolled or not
No
Yes
Give patient
caregiver
package &
label green
tracking form
Refer to the flowchart below, to ensure that all eligible patients can be
recruited in a smooth fashion. Please see Research Assistants or PEMMREP Volunteers for assistance.
SAFERVideo AOM
Eligible patient?
No
Track
Yes
Ask patient:
"Would they
like to hear
about study?"
No
Yes
RA Available? No
Page #4545 or notify
volunteer & Give RX
to patient
RA will notify MD if
patient enrolled or not
Track
Research so far...QAPPE
230TOTAL
Primary objectives are: Decreasing
unnecessary appendectomies (negative
appendectomies), Decreasing unnecessary
abdominal U/S and or CT scans, Decreasing
unnecessary hospital admissions for serial
examinations
Secondary objective is: Acting as a guide for
other centers in resource allocation and
referral patterns
Population: Pediatric patients (0-18 years)
presenting to the ED at MCH with abdominal
pain and suspected appendicitis
PATIENTS ENROLLED
ENROLLED (in January)
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SQUEEZE
PAGE #4552 if your patient:*On-call hours: 4:30 pm to 8:30 AM, please dial
x76443 to request page. Do not use 87* to send
page during on-call hours. If SQUEEZE Trial
pager unavailable page
Dr. Melissa Parker #2073TOTAL
73PATIENTS
ENROLLED
2ENROLLED (in January)
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Dr. Parker and the SQUEEZE team would like to thank all the PEM Physicians, Nurses
and Learners for their continued support in
screening for eligible study patients!
Volunteer of the Month
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Lindsay LaBrash
For the month of January, PEMMREP and the AOM/SAFER study
teams would like to honour Lindsay as the Volunteer of the Month!
Lindsay joined the PEMMREP program in September 2017. From
the get-go, we knew Lindsay would excel in this program. Lindsay
has been diligent and consistent throughout her volunteer
activities.
She can independently recruit for AOM studies and also has been
involved in additional studies such as Emergency Preparedness and
Febrile Neutropenia.
In addition to being a Life Sciences student, she is active in child
and maternal heath by working at a fertility clinic.
Currently, Lindsay is in her final year and hopes to pursue a
Masters.
Thank you Lindsay, for your continued support!
Have something to say in the next newsletter?Mohammed Hassan-Ali, MD, MSc Clinical Research Coordinator Division of Emergency Medicine Department of Pediatrics MUMC 2R107 [email protected] 905-521-2100 x 73864
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