Airway System of Care Assessment with High Fidelity Simulation

Abstract

Objective: 1) Determine the capacity of high-fidelity simulation in critical airway obstruction to assess the existing system of care at a pediatric institution. 2) Inform the development of a protocol for the multidisciplinary management of critical airway obstruction in the emergency department (ED) and the operating room (OR).

Method: Design was a prospective assessment, using simulation, of critical airway obstruction management at a pediatric referral center. Subjects were ED, OR, and otolaryngology (ENT) providers. We developed a novel simulation scenario of foreign body aspiration. Measures assessed included ED airway maneuvers, time to ENT arrival, and subject survey responses.

Results: Over 3 months, 67 providers participated in 6 simulations (3 complete in ED and 3 partial obstructions from ED to OR). The mean rating of simulation realism was 6.3 out of 7 (range, 4-7). Twenty-one of 67 (31%) providers stated they would apply something learned in the simulation to a real case. In 2 simulations, laryngoscopy was inappropriately performed and resulted in patient deterioration. In all simulations there was confusion about subspecialty consultation. ENT was consulted in all cases; the median time to ENT arrival was 6.8 minutes (range, 5.7-9 minutes). Identified system deficiencies included a lack of ENT equipment in the ED.

Conclusion: High-fidelity medical simulation is a safe, feasible, and effective method to assess current systems of care in high acuity, low frequency events. We will use the findings from these simulations to develop, implement, and reassess a protocol for the multidisciplinary management of pediatric critical airway obstruction at our institution.