(255) Defining Excellence During Pediatric Crisis Events

Tuesday, February 25, 2025

12:30pm – 1:30pm Eastern Time

Location: Connections Central - RST 02

First Author(s)

JB

Jacquelyn Benner, MD

United States

Co-Author(s)

Helen Harvey, MD, MS

Rady Children's Hospital - San Diego
San Diego, California, United States
MM

Matthew Murray, MD

Associate Professor of Pediatrics
University of California, San Diego, United States
MH

Maria Huang, MD

Assistant Professor of Pediatrics
University of California, San Diego, United States
EC

Elizabeth Chang, MD

Assistant Professor of Pediatrics
University of California, San Diego, United States
AS

Ashish Shah, MD

Associate Professor of Pediatrics
University of California, San Diego, United States
EZ

Elise Zimmerman, MD

Associate Professor of Pediatrics
University of California, San Diego, United States
BK

Ben Keller, MD

Assistant Professor of Surgery
University of California, San Diego, United States
RI

Romeo Ignacio, MD

Professor of Surgery
University of California, San Diego, United States
MD

Matthew Derkrikorian, BSN

Trauma Director
Rady Children's Hospital - San Diego, University of California, San Diego, United States

Introduction: Errors in medicine are frequently due to inferior teamwork and communication. Traditionally, the major focus has been on teaching the medical knowledge, and clinical and technical skills required for resuscitation. However, knowledge and clinical skills are insufﬁcient for successfully managing critical events. Non-technical or ‘human factors’ skills including communication, leadership and teamwork behaviors, and the principles of crisis resource management (CRM) are also of critical importance and have become the focus of education in critical care medicine.

Methods: Interprofessional clinicians from pediatric trauma surgery, emergency medicine, and pediatric critical care particpated in a survey to describe and define effective team performance, leadership, and communication during a pediatric crisis event. Qualitative and quantitative analysis was performed. Three investigators independently reviewed and coded open-ended survey responses using the constant comparative approach associated with grounded theory. Codes were developed by each investigator and reconciled through consensus to develop categories and themes. A third investigator reviewed all the code applications and categories for validation.

Results: 200 surveys were completed by physicians, nurses and respiratory therapists (RT). Descriptive themes differed between physician versus RT and nursing groups. Physicians described themes included: resuscitation experience and competency, shared mental model and anticipation. In comparision, nursing and RT clinicians favored themes: calm leadership, closed loop communication, and mutual respect. Over 75% of respondents were unfamiliar with CRM principles. All survey respondents favored additional resuscitation education to include: debriefing and more interdisciplinary simulation.

Conclusions: Non-technical or ‘human factors’ skills including communication, leadership and teamwork behaviors, and the principles of resource utilization are critical skill sets for our teams managing crisis events. These surveys will help to define attributes of effective and ineffective team leadership from the perspective of pediatric physicians, nurses, and respiratory therapists. This survey data from a large academic children's hospital reinforces the need for resuscitation program development.