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Enhanced training for healthcare teams who treat critically ill pediatric patients

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By Steven Gallagher

Soon after becoming Niagara Health’s Chief of Pediatrics more than three years ago, Dr. Madan Roy saw an opportunity to enhance training for healthcare teams who treat critically ill pediatric patients.

On average, approximately 20 per cent of cases seen in Niagara Health’s three Emergency Departments and two Urgent Care Centres are children under the age of 18. Among these, only a small number of patients present with life- or limb-threatening emergencies. But when they do, they need immediate, highly skilled care.

Niagara Health Emergency Department physicians and other members of the healthcare team participate in Pediatric Advanced Life Support (PALS) courses every two years. But given how infrequently they see pediatric emergencies, need for continuous training and upgrading of skills to care for these patients was identified.

In April 2017, Dr. Roy, who is also Deputy Chief at McMaster Children’s Hospital in Hamilton, in collaboration with Dr. Christopher Sulowski, Deputy Chief in the Division of Emergency Medicine at McMaster Children’s Hospital, Niagara Health’s Chief of Emergency Medicine Dr. Rafi Setrak, and South Niagara Deputy Chief of Emergency Medicine Dr. Shira Brown, along with others, started the Niagara-McMaster Pediatric Regional Skills Rounds.

The program sees healthcare providers from McMaster’s Pediatric Emergency Department, as part of the McMaster Pediatric Outreach Program (McPOP), coming on a rotating basis to Niagara Health’s Emergency Departments and Urgent Care Centres to provide hands-on simulation-based training to physicians, nurses, respiratory therapists and paramedics from Niagara Emergency Medical Services.

Defusing an angry or upset patient

The training involves real-life scenarios such as resuscitation of children presenting with sepsis, seizures, hypothermia and bronchiolitis. A mannequin is used as the patient during the training. The Niagara Health team performs all steps of resuscitation in each of the scenarios under the watchful eyes of the McMaster team. Afterward, the group discusses the process and possible improvements to care.

“We give them a real-life case, then they work their way through it,” says Dr. Roy. “They feel it’s real life, their skills have improved and they’re more able to problem-solve on the spot. They’re much more confident if a similar situation comes in next time, with the whole team performing together better.”

Dr. Sulowski is the leader of the newly formed McPOP program. The collaboration with Niagara Health is McPOP’s pilot project.

Dr. Sulowski says the first half hour or hour of treatment is essential in caring for critically ill pediatric patients.

Experience a shift in the emergency department

“The goal of these training sessions is to remind the healthcare teams of those goals in that first half-hour of treatment.”

The hands-on training is vital, says Dr. Sulowski.

“We want to make sure the teams are comfortable and that they have the skills to do it and responding to what they’re seeing,” he says. “We’re trying to give them everything in real time. We didn’t want to do a lecture with slides. We wanted them to be in the moment.”

The training focuses on the importance of teamwork and communication amongst the healthcare providers.

Feedback from training participants has been positive.

“It’s a tremendous help,” says Dr. Charlene Wayda, a physician at Niagara Health’s Urgent Care Centre in Port Colborne. “This reinforces our bi-yearly training from the PALS course. The (McMaster) training has supported my learning and created new ideas and new techniques. This is extremely beneficial. It is invaluable.”

The training will be ongoing for the Niagara Health team, adds Dr. Roy.

“We felt it is really important to do continuous quality improvement, which means we keep coming back,” he says. “It will provide better outcomes.”

Steven Gallagher is a Communications Specialist at Niagara Health.

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