Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool.

Autor: Lerner C; Division of Pediatric Radiology, Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA. lerne003@mc.duke.edu, Gaca AM, Frush DP, Hohenhaus S, Ancarana A, Seelinger TA, Frush K
Jazyk: angličtina
Zdroj: Pediatric radiology [Pediatr Radiol] 2009 Jul; Vol. 39 (7), pp. 703-9. Date of Electronic Publication: 2009 May 13.
DOI: 10.1007/s00247-009-1265-y
Abstrakt: Background: Though rare, allergic reactions occur as a result of administration of low osmolality nonionic iodinated contrast material to pediatric patients. Currently available resuscitation aids are inadequate in guiding radiologists' initial management of such reactions.
Objective: To compare radiology resident competency with and without a computer-based interactive resuscitation tool in the management of life-threatening events in pediatric patients.
Materials and Methods: The study was approved by the IRB. Radiology residents (n = 19; 14 male, 5 female; 19 certified in basic life support/advanced cardiac life support; 1 certified in pediatric advanced life support) were videotaped during two simulated 5-min anaphylaxis scenarios involving 18-month-old and 8-year-old mannequins (order randomized). No advance warning was given. In half of the scenarios, a computer-based interactive resuscitation tool with a response-driven decision tree was available to residents (order randomized). Competency measures included: calling a code, administering oxygen and epinephrine, and correctly dosing epinephrine.
Results: Residents performed significantly more essential interventions with the computer-based resuscitation tool than without (72/76 vs. 49/76, P < 0.001). Significantly more residents appropriately dosed epinephrine with the tool than without (17/19 vs. 1/19; P < 0.001). More residents called a code with the tool than without (17/19 vs. 14/19; P = 0.08). A learning effect was present: average times to call a code, request oxygen, and administer epinephrine were shorter in the second scenario (129 vs. 93 s, P = 0.24; 52 vs. 30 s, P < 0.001; 152 vs. 82 s, P = 0.025, respectively). All the trainees found the resuscitation tool helpful and potentially useful in a true pediatric emergency.
Conclusion: A computer-based interactive resuscitation tool significantly improved resident performance in managing pediatric emergencies in the radiology department.
Databáze: MEDLINE
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