David O Kessler1,2, Todd P Chang3,4, Marc Auerbach5, Daniel M Fein6,7, Megan E Lavoie8,9, Jennifer Trainor10,11, Moon O Lee12, James M Gerard13,14, Devin Grossman15,16, Travis Whitfill17, Martin Pusic18. 1. Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA. 2. Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York, USA. 3. Department of Clinical Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA. 4. Children's Hospital of Los Angeles, Los Angeles, California, USA. 5. Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. 6. Department of Pediatrics, Albert Einstein College of Medicine, New York, New York, USA. 7. Children's Hospital at Montefiore, Bronx, NY, New York, USA. 8. Department of Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 9. The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 10. Department of Pediatrics-Emergency Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 11. Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA. 12. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA. 13. Department of Pediatrics, Saint Louis University Health Sciences Center, Saint Louis, Missouri, USA. 14. SSM Cardinal Glennon Children's Medical Center, Saint Louis, Missouri, USA. 15. Department of Pediatrics, Emergency Medicine, Stony Brook Medicine, New York, USA. 16. Stony Brook Children's Hospital, New York, USA. 17. Yale School of Medicine, New Haven, Connecticut, USA. 18. Department of Emergency Medicine, New York University Langone Medical Center, New York, New York, USA.
Abstract
Background: Determining when to entrust trainees to perform procedures is fundamental to patient safety and competency development. Objective: To determine whether simulation-based readiness assessments of first year residents immediately prior to their first supervised infant lumbar punctures (LPs) are associated with success. Methods: This prospective cohort study enrolled paediatric and other first year residents who perform LPs at 35 academic hospitals from 2012 to 2014. Within a standardised LP curriculum, a validated 4-point readiness assessment of first year residents was required immediately prior to their first supervised LP. A score ≥3 was required for residents to perform the LP. The proportion of successful LPs (<1000 red blood cells on first attempt) was determined. Process measures included success on any attempt, number of attempts, analgesia usage and use of the early stylet removal technique. Results: We analysed 726 LPs reported from 1722 residents (42%). Of the 432 who underwent readiness assessments, 174 (40%, 95% CI 36% to 45%) successfully performed their first LP. Those who were not assessed succeeded in 103/294 (35%, 95% CI 30% to 41%) LPs. Assessed participants reported more frequent direct attending supervision of the LP (diff 16%; 95% CI 8% to 22%), greater use of topical analgesia (diff 6%; 95% CI 1% to 12%) and greater use of the early stylet removal technique (diff 11%; 95% CI 4% to 19%) but no difference in number of attempts or overall procedural success. Conclusions: Simulation-based readiness assessments performed in a point-of-care fashion were associated with several desirable behaviours but were not associated with greater clinical success with LP. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Background: Determining when to entrust trainees to perform procedures is fundamental to patient safety and competency development. Objective: To determine whether simulation-based readiness assessments of first year residents immediately prior to their first supervised infant lumbar punctures (LPs) are associated with success. Methods: This prospective cohort study enrolled paediatric and other first year residents who perform LPs at 35 academic hospitals from 2012 to 2014. Within a standardised LP curriculum, a validated 4-point readiness assessment of first year residents was required immediately prior to their first supervised LP. A score ≥3 was required for residents to perform the LP. The proportion of successful LPs (<1000 red blood cells on first attempt) was determined. Process measures included success on any attempt, number of attempts, analgesia usage and use of the early stylet removal technique. Results: We analysed 726 LPs reported from 1722 residents (42%). Of the 432 who underwent readiness assessments, 174 (40%, 95% CI 36% to 45%) successfully performed their first LP. Those who were not assessed succeeded in 103/294 (35%, 95% CI 30% to 41%) LPs. Assessed participants reported more frequent direct attending supervision of the LP (diff 16%; 95% CI 8% to 22%), greater use of topical analgesia (diff 6%; 95% CI 1% to 12%) and greater use of the early stylet removal technique (diff 11%; 95% CI 4% to 19%) but no difference in number of attempts or overall procedural success. Conclusions: Simulation-based readiness assessments performed in a point-of-care fashion were associated with several desirable behaviours but were not associated with greater clinical success with LP. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Entities:
Keywords:
patient safety; pediatrics; simulation; training
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