O3287: Standardized Practice Guideline Application in the Assessment of Multi-center Pediatric Critical Care Transport Team Performance

Background: The use of pediatric critical care transport teams improves clinical outcomes in children. There is significant variability in training requirement, certification, and the use of simulation as an educational tool.

Methods: This is a multisite, prospective, simulation-based study including 12 centers in North America. We aimed to determine PCCT performance using simulated scenarios chosen to follow current practice guidelines in cardiac arrest, traumatic brain injury and sepsis. Simulation cases and assessment checklists were developed and polished through a modified Delphi panel, pilot testing and revision. Raters were trained by the study PIs. Each transport team of 2-3 PCCT members participated in 3 in-situ simulations: two in ambulance: (a) cardiac arrest and (b) abusive head injury with increased intracranial pressure, and one at the referring ED: sepsis. The primary outcome was team performance, measured using a composite quality score (CQS) based on the number of actions executed correctly on the performance checklists.

Results: A total of 74 PCCTs participated in this study, encompassing 231 members from 12 different transport centers (Table 1). Team members included 115 (49.8%) nurses, 56 (24.2%) respiratory therapists (RT), 37 (16%) paramedics and 23 (9.9%) EMT-B. All teams (100%) included nurses and 70.3% included RTs. Mean CQS for the simulated cases: cardiac 79.8% (SD 18.2), abusive head injury 87.2% (SD 17.2) and sepsis 63.4% (SD 21.4) (Table 2).
Clustered mixed effects models (simulated team performance was clustered within each center) were conducted for the 3 simulations, with annual pediatric volume, patient population, PCCT use of simulation training, and use of an RT, as covariates, with the simulated CQS as the outcome. The mixed effects model was only significant for the sepsis simulation with higher pediatric volume (p = 0.02) and use of simulation for training (p = 0.04) predicting higher CQS scores.

Conclusion: These results show a preference in all centers within this cohort to use nurse-led teams for PCCT. Variability in performance using simulated scenarios was found, with better adherence to guidelines in centers with a higher volume of pediatric patients and the inclusion of simulation-based training. These data provide evidence that variability in adherence to current clinical guidelines can be tested using simulation. Future development of national pediatric transport team practice standards can improve clinical outcomes.