O3295: Impact of Pediatric Critical Care Transport Team Simulations - Qualitative Analysis of Debriefs from the Impacts Transport Simulation Study

Background: Pediatric critical care transport teams (PCCT) are trained to care for pediatric patients under various circumstances. The ImPACTS simulation-based, multi-center, single-arm cohort study, characterized PCCT performance and the impact of transport center and team characteristics on team performance metrics.

Methods: This qualitative study was conducted to explore the impact of simulation training in pediatric critical transport teams in order to answer the question: How do programs experience pediatric critical care transport team education using simulation? 12 transport centers nationwide participated in the multi-center ImPACTS transport simulation study in which simulation was utilized to measure and compare PCCT performance. Three simulated cases with linked assessment tools were developed by content experts. Each transport team of 2-3 PCCT members participated in 2 in-situ (in an ambulance) simulations with scenarios on (a) cardiac arrest and (b) abusive head trauma with increased intracranial pressure. The third simulation, (c) sepsis, was done in a simulated ED. Each simulation was followed by a facilitated debriefing session. Debriefing sessions were digitally recorded, and sessions with adequate audio quality were transcribed for qualitative analysis. A grounded theory approach was used to identify themes representing elements of practices, thoughts and beliefs in an effort to better understand how facilitators led debriefs and how transport teams perceive critical care transport team education using simulation.

Results: A total of 74 transport teams composed of nurses, respiratory therapists, paramedics and/or EMTs from 12 centers participated in the ImPACTS transport simulation study. Qualitative analysis was conducted on 23 debriefing sessions from 6 centers (7 cardiac arrest, 8 abusive head trauma and 8 sepsis scenarios). Themes were identified in 5 categories: conversational techniques, including advocacy inquiry, directive feedback, and learner self-assessment; debriefing elements, including shared mental model and addressing learning objectives; latent safety threats, including personnel/staffing, protocols, and workspace/environment; response to simulation; and team dynamics (Table 1).

Conclusion: Simulation and debrief facilitators used consistent conversational techniques and debriefing components to help simulation participants process their experience. In general, transport team members found simulation to be realistic and helpful, and were also able to use simulation to identify latent safety threats in their work. Simulation could be used more consistently for transport team training and continuing education.