Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool.
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.
Lerner, C; Gaca, AM; Frush, DP; Hohenhaus, S; Ancarana, A; Seelinger, TA; Frush, K
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