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A Randomized, Controlled Trial of In Situ Pediatric Advanced Life Support Recertification (Pediatric Advanced Life Support Reconstructed) Compared With Standard Pediatric Advanced Life Support Recertification for ICU Frontline Providers*

Kurosawa, Hiroshi MD1; Ikeyama, Takanari MD1,2; Achuff, Patricia MBA, RRT-NPS3; Perkel, Madeline MSN, CRNP4; Watson, Christine BSN, RN4; Monachino, AnneMarie MSN, RN, CPN1; Remy, Daphne MD5; Deutsch, Ellen MD1,6; Buchanan, Newton1; Anderson, JoDee MD, MEd7; Berg, Robert A. MD6; Nadkarni, Vinay M. MD, MS1,6; Nishisaki, Akira MD, MSCE1,6

Critical Care Medicine:
doi: 10.1097/CCM.0000000000000024
Clinical Investigations
Abstract

Objective: Recent evidence shows poor retention of Pediatric Advanced Life Support provider skills. Frequent refresher training and in situ simulation are promising interventions. We developed a “Pediatric Advanced Life Support–reconstructed” recertification course by deconstructing the training into six 30-minute in situ simulation scenario sessions delivered over 6 months. We hypothesized that in situ Pediatric Advanced Life Support–reconstructed implementation is feasible and as effective as standard Pediatric Advanced Life Support recertification.

Design: A prospective randomized, single-blinded trial.

Setting: Single-center, large, tertiary PICU in a university-affiliated children’s hospital.

Subjects: Nurses and respiratory therapists in PICU.

Interventions: Simulation-based modular Pediatric Advanced Life Support recertification training.

Measurements and Main Results: Simulation-based pre- and postassessment sessions were conducted to evaluate participants’ performance. Video-recorded sessions were rated by trained raters blinded to allocation. The primary outcome was skill performance measured by a validated Clinical Performance Tool, and secondary outcome was behavioral performance measured by a Behavioral Assessment Tool. A mixed-effect model was used to account for baseline differences. Forty participants were prospectively randomized to Pediatric Advanced Life Support reconstructed versus standard Pediatric Advanced Life Support with no significant difference in demographics. Clinical Performance Tool score was similar at baseline in both groups and improved after Pediatric Advanced Life Support reconstructed (pre, 16.3 ± 4.1 vs post, 22.4 ± 3.9; p < 0.001), but not after standard Pediatric Advanced Life Support (pre, 14.3 ± 4.7 vs post, 14.9 ± 4.4; p =0.59). Improvement of Clinical Performance Tool was significantly higher in Pediatric Advanced Life Support reconstructed compared with standard Pediatric Advanced Life Support (p = 0.006). Behavioral Assessment Tool improved in both groups: Pediatric Advanced Life Support reconstructed (pre, 33.3 ± 4.5 vs post, 35.9 ± 5.0; p = 0.008) and standard Pediatric Advanced Life Support (pre, 30.5 ± 4.7 vs post, 33.6 ± 4.9; p = 0.02), with no significant difference of improvement between both groups (p = 0.49).

Conclusions: For PICU-based nurses and respiratory therapists, simulation-based “Pediatric Advanced Life Support–reconstructed” in situ training is feasible and more effective than standard Pediatric Advanced Life Support recertification training for skill performance. Both Pediatric Advanced Life Support recertification training courses improved behavioral performance.

Author Information

1Center for Simulation, Advanced Education and Innovation, The Children’s Hospital of Philadelphia, Philadelphia, PA.

2Tokyo Metropolitan Children’s Medical Centre, Tokyo, Japan.

3Department of Respiratory Care, The Children’s Hospital of Philadelphia, Philadelphia, PA.

4Department of Nursing, The Children’s Hospital of Philadelphia, Philadelphia, PA.

5Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA.

6Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA.

7Division of Neonatal and Perinatal Medicine, Oregon Health and Science University, Portland, OR.

* See also p. 744.

Supported, in part, by Children’s Hospital of Philadelphia Critical Care Medicine Endowed Chair Fund and Laerdal Foundation for Acute Care Medicine Center of Excellence Grant.

Dr. Anderson consulted for SimHealth Consultants and STABLE Program. Dr. Nishisaki’s institution received grant support from the Laerdal Center for Excellence and from Agency for Healthcare Research and Quality (R03HS021583) (Evaluation of current tracheal intubation practice in multiple PICU). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Akira Nishisaki, MD, MSCE, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, 8 NE Suite 8566, 34th Street Civic Center Boulevard, Philadelphia, PA 19104. E-mail: nishisaki@email.chop.edu

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins