Jodi Thrasher1, Joyce Baker2, Kathleen M Ventre3, Sara E Martin2, Jessica Dawson2, Roberta Cox2, Heather M Moore4, Sarah Brethouwer2, Sharon Sables-Baus5, Christopher D Baker4. 1. Children's Hospital Colorado, Aurora, CO, USA. Electronic address: Jodi.Thrasher@childrenscolorado.org. 2. Children's Hospital Colorado, Aurora, CO, USA. 3. Department of Pediatrics/Critical Care Medicine Baystate Children's Hospital, Springfield, MA, USA. 4. Children's Hospital Colorado, Aurora, CO, USA; Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. 5. Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado, College of Nursing & School of Medicine, USA.
Abstract
BACKGROUND: Preparing families of children requiring long-term mechanical ventilation (LTMV) to manage medical emergencies at home is challenging. Opportunities for family caregivers to rehearse crisis management in a controlled setting before discharge are limited. OBJECTIVE: We aimed to create a multimodal discharge preparedness curriculum, incorporating high-fidelity simulation training, to prepare family caregivers of children with complex medical conditions requiring long-term mechanical ventilation. We sought to determine which curricular elements were most helpful and whether this curriculum impacted the rate of readmissions within 7 days of hospital discharge. METHODS: The curriculum included instructional videos, printed handouts, cardiopulmonary resuscitation training, and two mandatory high fidelity simulation scenarios depicting tracheostomy- and ventilator-related emergencies. Teams of one to three family caregivers per patient managed each scenario. A video-based debriefing focused on identifying and closing performance gaps. Participants rated their perceptions regarding each curricular element and its relative impact on their preparedness for discharge. RESULTS: 87 family caregivers completed the curriculum. Simulation-enhanced curriculum was well-received by participants. Participants reported that post-simulation debriefing was the most beneficial component. We observed a trend toward reduced readmissions within 7 days of discharge since implementation of our revised curriculum. CONCLUSION: Simulation training can be incorporated into discharge training for families of children requiring LTMV. Rehearsal of emergency management in a simulated clinical setting increases caregiver confidence to assume care for their ventilator-dependent child.
BACKGROUND: Preparing families of children requiring long-term mechanical ventilation (LTMV) to manage medical emergencies at home is challenging. Opportunities for family caregivers to rehearse crisis management in a controlled setting before discharge are limited. OBJECTIVE: We aimed to create a multimodal discharge preparedness curriculum, incorporating high-fidelity simulation training, to prepare family caregivers of children with complex medical conditions requiring long-term mechanical ventilation. We sought to determine which curricular elements were most helpful and whether this curriculum impacted the rate of readmissions within 7 days of hospital discharge. METHODS: The curriculum included instructional videos, printed handouts, cardiopulmonary resuscitation training, and two mandatory high fidelity simulation scenarios depicting tracheostomy- and ventilator-related emergencies. Teams of one to three family caregivers per patient managed each scenario. A video-based debriefing focused on identifying and closing performance gaps. Participants rated their perceptions regarding each curricular element and its relative impact on their preparedness for discharge. RESULTS: 87 family caregivers completed the curriculum. Simulation-enhanced curriculum was well-received by participants. Participants reported that post-simulation debriefing was the most beneficial component. We observed a trend toward reduced readmissions within 7 days of discharge since implementation of our revised curriculum. CONCLUSION: Simulation training can be incorporated into discharge training for families of children requiring LTMV. Rehearsal of emergency management in a simulated clinical setting increases caregiver confidence to assume care for their ventilator-dependent child.
Keywords:
Discharge teaching (5); Interprofessional care team; Long-term mechanical ventilation; Simulation training for family caregivers; Tracheostomy
Authors: Laura G Amar-Dolan; Mary H Horn; Brianna O'Connell; Susan K Parsons; Christopher J Roussin; Peter H Weinstock; Robert J Graham Journal: Ann Am Thorac Soc Date: 2020-07