Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments

David O Kessler; Todd P Chang; Marc Auerbach; Daniel M Fein; Megan E Lavoie; Jennifer Trainor; Moon O Lee; James M Gerard; Devin Grossman; Travis Whitfill; Martin Pusic

doi:10.1136/bmjstel-2016-000130

Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments

BMJ Simul Technol Enhanc Learn. 2016 Oct 28;3(1):17-22. doi: 10.1136/bmjstel-2016-000130. eCollection 2017.

Authors

David O Kessler^{1

2}, Todd P Chang^{3

4}, Marc Auerbach⁵, Daniel M Fein^{6

7}, Megan E Lavoie^{8

9}, Jennifer Trainor^{10

11}, Moon O Lee¹², James M Gerard^{13

14}, Devin Grossman^{15

16}, Travis Whitfill¹⁷, Martin Pusic¹⁸

Affiliations

¹ Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA.
² Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York, USA.
³ Department of Clinical Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
⁴ Children's Hospital of Los Angeles, Los Angeles, California, USA.
⁵ Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
⁶ Department of Pediatrics, Albert Einstein College of Medicine, New York, New York, USA.
⁷ Children's Hospital at Montefiore, Bronx, NY, New York, USA.
⁸ Department of Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁹ The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁰ Department of Pediatrics-Emergency Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹¹ Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
¹² Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.
¹³ Department of Pediatrics, Saint Louis University Health Sciences Center, Saint Louis, Missouri, USA.
¹⁴ SSM Cardinal Glennon Children's Medical Center, Saint Louis, Missouri, USA.
¹⁵ Department of Pediatrics, Emergency Medicine, Stony Brook Medicine, New York, USA.
¹⁶ Stony Brook Children's Hospital, New York, USA.
¹⁷ Yale School of Medicine, New Haven, Connecticut, USA.
¹⁸ Department of Emergency Medicine, New York University Langone Medical Center, New York, New York, USA.

Abstract

Background: Determining when to entrust trainees to perform procedures is fundamental to patient safety and competency development.

Objective: To determine whether simulation-based readiness assessments of first year residents immediately prior to their first supervised infant lumbar punctures (LPs) are associated with success.

Methods: This prospective cohort study enrolled paediatric and other first year residents who perform LPs at 35 academic hospitals from 2012 to 2014. Within a standardised LP curriculum, a validated 4-point readiness assessment of first year residents was required immediately prior to their first supervised LP. A score ≥3 was required for residents to perform the LP. The proportion of successful LPs (<1000 red blood cells on first attempt) was determined. Process measures included success on any attempt, number of attempts, analgesia usage and use of the early stylet removal technique.

Results: We analysed 726 LPs reported from 1722 residents (42%). Of the 432 who underwent readiness assessments, 174 (40%, 95% CI 36% to 45%) successfully performed their first LP. Those who were not assessed succeeded in 103/294 (35%, 95% CI 30% to 41%) LPs. Assessed participants reported more frequent direct attending supervision of the LP (diff 16%; 95% CI 8% to 22%), greater use of topical analgesia (diff 6%; 95% CI 1% to 12%) and greater use of the early stylet removal technique (diff 11%; 95% CI 4% to 19%) but no difference in number of attempts or overall procedural success.

Conclusions: Simulation-based readiness assessments performed in a point-of-care fashion were associated with several desirable behaviours but were not associated with greater clinical success with LP.

Keywords: patient safety; pediatrics; simulation; training.

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