P3.231: Adult and Pediatric Rapid Response Training for Pediatric Residents - Impact of SimulationBoot Camp

Background: Rapid response teams (RRTs) are essential in children’s hospitals to provide early intervention in critical emergencies. Notably, nonhospitalized adult emergencies are also common in children's hospitals. Pediatric residents often feel unprepared due to lack of training and experience. To address this, we developed a simulation boot camp to augment their confidence in management of adult and pediatric rapid response (RR).

Methods: A multidisciplinary team conducted full-day simulation boot camps for 2nd and 3rd year residents, on separate dates, focusing on leading RRT. They were scheduled in the beginning of the year to prepare for the transition into senior roles. Residents participated in teams of 4 and rotated through simulation stations focused on pediatric status epilepticus, pediatric respiratory failure, and unresponsive adult. Each 45-minute session included high-fidelity mannequin simulations followed by faculty-led debriefing. Additionally, one station focused on features of RRs and codes utilizing case-based formats. Two procedural stations focused on different modes of access, oxygenation, ventilation and airway management. Residents completed pre- and post-surveys to measure impact.

Results: A total of 30 PGY-2 and 26 PGY-3 residents participated in the boot camp. At the beginning of second year, 80% responded to participating in 3-5 pediatric RR and 53% responded to participating in 1-2 adult RR. After the bootcamp, residents felt more confident in resources for RR vs Code Blue (difference in medians (M)=-1, p= < 0.0001), activation of RR vs Code Blue (M=-2, p= < 0.0001), recognition of clinical decompensation (M=-1, p= < 0.0001), critical medication utilization (M=-1, p= < 0.0001), adult RR disposition (M=-2, p= < 0.0001) [figure 1]. Pre- survey resident comfort in leading pediatric versus adult RR was statistically different (p= < 0.04). However, post-intervention, residents reported same comfort level in managing two different patient populations [Figure 2] and had a higher impact on comfort in leading an adult RR versus pediatric RR. Self-reported comfort in common adult emergencies also improved; unresponsive adult (M=-1, p= < 0.001 ), adult with chest pain (M=-1, p= < 0.0001), and seizing adult (M=-1, p= < 0.0001). Key concerns included task priority and independent decision-making for leading both pediatric and adult RR. However, task delegation was the primary concern in pediatrics versus medical knowledge in adults. Notably, 46% felt PALS certification alone was insufficient for RR, while 78% believed ACLS certification would benefit pediatric trainees in tertiary hospitals.

Conclusion: Pediatric residents feel uncertain in managing RRs, especially adult emergencies, highlighting the need for structured training. Our simulation boot camp significantly improved self-reported confidence in leading and participating in pediatric and adult RRs and successfully boosted resident comfort to the same level in leading both adult and pediatric RRs. In institutions where year-long simulation curriculum isn't feasible, simulation boot camp addressing high-yield topics in both pediatric and adult RRs can significantly impact resident preparedness.