Inside Pediatrics Summer 2019

Pediatric simulation at heart of training program for Alabama community hospitals

Children’s of Alabama COACHES promotes education, research and the delivery of safe, innovative health care

F ive-year-old Caleb lay in a hospital bed in the Emergency Department at Children’s of Alabama with tears rolling down his cheeks as Stacy Gaither, MSN, RN, attempted to wipe them away. Chrystal Rutledge, M.D., sat nearby on her laptop computer, controlling Caleb’s loud sobs with a click of the touchpad. Seconds later, the crying ceased. The tears dried as quickly as they came. Caleb is not a human patient – he’s the world’s most advanced pediatric patient simulator and the first capable of simulating lifelike emotions through dynamic facial expressions, movement and speech, according to his maker, medical training company Gaumard Scientific. Caleb can answer questions, follow fingers with his eyes, exclaim “Ow!” when pricked with a needle and mimic the symptoms of various medical ailments. Caleb’s human likeness may be eerie to some, but to the simulation team, it’s the cutting- edge of scenario-based simulation training. Caleb is the newest addition to the Children’s of Alabama Community Healthcare Education Simulation Program, also known as COACHES. Established in 2016, COACHES is a free pediatric community outreach simulation program with a goal of improving pediatric care in community hospitals throughout Alabama. Rutledge, COACHES Program director, is also an assistant professor at the University of Alabama at Birmingham (UAB) School of Medicine in the Department of Pediatrics,

of critically ill patients will not receive initial care at a pediatric trauma center like Children’s. “Very few community hospitals have the resources or access to a provider with significant experience in caring for critically ill children,” Rutledge said. “It is vital that community hospitals are experienced and comfortable when taking care of sick children to ensure they have appropriate, time- sensitive treatment.” Rural physicians have reported a greater need for continuing medical education regarding pediatric emergency procedures. Rutledge said Children’s receives 36% of its admissions from community hospitals. The core of the COACHES Program is simulation training, which uses technology to recreate real-life scenarios without having to wait for the actual experience. Studies have shown simulation-based assessments and educational programs can improve provider skills and performance, improve patient outcomes and reduce errors. An added bonus, Waddell said, is forming and strengthening relationships between pediatric specialty groups and community health providers. An onsite visit includes two separate two-and-a-half to three-hour simulation sessions with Caleb and Eloise, the child and infant pediatric patient simulators, respectively. Four real-life scenarios are conducted during each session. For each scenario, a medical management checklist, including national care guidelines or best practice metrics, is used to evaluate hospital health care team performance.

associate medical director of the Pediatric Simulation Center at Children’s and medical director of the Critical Care Transport Team at Children’s. Gaither, COACHES Program Research Coordinator, is also research director of Children’s simulation center.

Caleb can answer questions, follow fingers with his eyes, exclaim “Ow!” when pricked with a needle and mimic the symptoms of various medical ailments.

Kristen Waddell, MSN, CRNP, CCRN, COACHES Program Coordinator and a PICU nurse practitioner, rounds out the team, and together they have traveled to more than 30 community hospital emergency departments and inpatient pediatric units since the program’s inception. Community emergency departments are usually the first care providers for pediatric patients, and up to 90%

Team communication is evaluated using a validated tool, and a team debriefing follows each simulation scenario. The debriefing focuses on positive aspects of medical management, improvement opportunities, communication and barriers to patient care, including suggestions to overcome them. A report including the results of the survey, as well as the overall performance score for both sessions, is

7