Barbara M Walsh1, Sandeep Gangadharan1, Travis Whitfill2, Marcie Gawel2, David Kessler3, Robert A Dudas4, Jessica Katznelson4, Megan Lavoie5, Khoon-Yen Tay5, Melinda Hamilton6, Linda L Brown7, Vinay Nadkarni8, Marc Auerbach2. 1. Department of Pediatrics, Cohen's Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, New York. 2. Department of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut. 3. Department of Pediatrics, Columbia University Medical Center, Presbyterian Morgan Stanley Children's Hospital of New York, New York, New York. 4. Department of Pediatrics and Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. 5. Department of Pediatrics and Emergency Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Division of Emergency Medicine, Philadelphia, Pennsylvania. 6. Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 7. Department of Pediatrics and Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island. 8. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Errors in the timely diagnosis and treatment of infants with hypoglycemic seizures can lead to significant patient harm. It is challenging to precisely measure medical errors that occur during high-stakes/low-frequency events. Simulation can be used to assess risk and identify errors. OBJECTIVE: We hypothesized that general emergency departments (GEDs) would have higher rates of deviations from best practices (errors) compared to pediatric emergency departments (PEDs) when managing an infant with hypoglycemic seizures. METHODS: This multicenter simulation-based prospective cohort study was conducted in GEDs and PEDs. In situ simulation was used to measure deviations from best practices during management of an infant with hypoglycemic seizures by inter-professional teams. Seven variables were measured: five nonpharmacologic (i.e., delays in airway assessment, checking dextrose, starting infusion, verbalizing disposition) and two pharmacologic (incorrect dextrose dose and incorrect dextrose concentration). The primary aim was to describe and compare the frequency and types of errors between GEDs and PEDs. RESULTS: Fifty-eight teams from 30 hospitals (22 GEDs, 8 PEDs) were enrolled. Pharmacologic errors occurred more often in GEDs compared to PEDs (p = 0.043), while nonpharmacologic errors were uncommon in both groups. Errors more frequent in GEDs related to incorrect dextrose concentration (60% vs. 88%; p = 0.025), incorrect dose (20% vs. 56%; p = 0.033), and failure to start maintenance dextrose (33% vs. 65%; p = 0.040). CONCLUSIONS: During the simulated care of an infant with hypoglycemic seizures, errors were more frequent in GEDs compared to PEDs. Decreasing annual pediatric patient volume was the best predictor of errors on regression analysis.
BACKGROUND: Errors in the timely diagnosis and treatment of infants with hypoglycemic seizures can lead to significant patient harm. It is challenging to precisely measure medical errors that occur during high-stakes/low-frequency events. Simulation can be used to assess risk and identify errors. OBJECTIVE: We hypothesized that general emergency departments (GEDs) would have higher rates of deviations from best practices (errors) compared to pediatric emergency departments (PEDs) when managing an infant with hypoglycemic seizures. METHODS: This multicenter simulation-based prospective cohort study was conducted in GEDs and PEDs. In situ simulation was used to measure deviations from best practices during management of an infant with hypoglycemic seizures by inter-professional teams. Seven variables were measured: five nonpharmacologic (i.e., delays in airway assessment, checking dextrose, starting infusion, verbalizing disposition) and two pharmacologic (incorrect dextrose dose and incorrect dextrose concentration). The primary aim was to describe and compare the frequency and types of errors between GEDs and PEDs. RESULTS: Fifty-eight teams from 30 hospitals (22 GEDs, 8 PEDs) were enrolled. Pharmacologic errors occurred more often in GEDs compared to PEDs (p = 0.043), while nonpharmacologic errors were uncommon in both groups. Errors more frequent in GEDs related to incorrect dextrose concentration (60% vs. 88%; p = 0.025), incorrect dose (20% vs. 56%; p = 0.033), and failure to start maintenance dextrose (33% vs. 65%; p = 0.040). CONCLUSIONS: During the simulated care of an infant with hypoglycemic seizures, errors were more frequent in GEDs compared to PEDs. Decreasing annual pediatric patient volume was the best predictor of errors on regression analysis.
Authors: Jennifer Mitzman; Ilana Bank; Rebekah A Burns; Michael C Nguyen; Pavan Zaveri; Michael J Falk; Manu Madhok; Ann Dietrich; Jessica Wall; Muhammad Waseem; Teresa Wu; Alisa McQueen; Cynthia R Peng; Brian Phillips; Francesca M Bullaro; Cindy D Chang; Sam Shahid; David P Way; Marc Auerbach Journal: AEM Educ Train Date: 2019-12-12