Treating Children Like Children

Children are not just small adults. Obvious, right? But, if you were to ask those in pediatrics, they might say that a lot can get missed in the obvious.

Over the past twenty years, emergency departments (EDs) nationally have seen an increase in patients, and nearly 25 percent of these are children.¹Experts worry that, because children are being brought primarily to facilities that do not specialize in pediatric care, children may not be receiving the specialized treatment they deserve.²Children, particularly infants less than one year old, have significant anatomical and physiological differences from adults, and the course of care necessary to diagnose and treat them is unique—unique and often missed.

In an emergency, a child's condition can deteriorate quickly, parents on scene can panic, and the care team at the bedside is likely to experience degrees of stress. Because of this,there is an urgent need to improve pediatric training—to ensure that when we say “children are not just small adults” we are not missing something.

专家们将重点放在确定适当的临床途径，管理药物和在跨学科团队中工作的培训。研究表明，这三个领域的培训可以对儿科患者的结局产生积极影响。

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In this article, we discuss how pediatric simulation can be used to train for:

During physical assessments, infants are not able to articulate what hurts, explain what happened, or raise concerns about prior procedures or complications. In these cases, it's critically important to listen to the parent, guardian, or social worker, because they will know the child's baseline. This is the start of the clinical pathway, or what some call the "blueprint for a plan of care".³

Many organizations have begun implementing full-scale pediatric simulation efforts, according to the American Academy of Pediatrics (AAP). One example is the Pediatric BASE Camp, an immersive simulation event supported by Laerdal and hosted by Weill Cornell Medical College, that focuses on fine-tuning and strengthening the clinical-pathway skills that providers use when faced with a pediatric emergency.⁴

Other organizations are using sequential simulation (SqS) to prepare front-line staff to participate in integrated, or person-centered, care at various points on the patient journey.⁵This form of simulation focuses on important moments, such as hand-offs (i.e. from parent to physician, from ambulance to ED, etc.), information sharing, role assignments, and individual tasks.

能够评估症状，衡量生理差异和改善并进行干预措施将使学习者暂停怀疑并在没有障碍的情况下通过模拟。

In pediatrics, the incidence of errors with medication can be as high as 1 in every 6 orders.⁷This may be caused, in part, by the fact that children vary greatly in weight, body surface area, and organ system maturity, which affects their ability to metabolize and excrete medications.⁸

在一项研究的研究中，使用模拟来观察护理学生来解决复杂的儿科患者病例，只有22％的学生在培训前提供了正确的药物管理。训练后，96％的稀释技术成功，而百分之八十八能够提供准确的IV泵率。¹⁰

Simulation training prepares nurses and physicians for the inevitable stress, noise, and chaos that will come with an infant in critical condition.

When an infant is brought to the ED, it's quite possible that a team can form that has little familiarity with each other and yet must perform like a well oiled machine. So, why not give them that training opportunity?

辛辛那提儿童医院医学中心的研究主张高保真模拟是在儿科创伤患者的背景下增强和评估跨学科团队培训的有效方法。¹¹This same study concluded that improved team performance directly correlated with more efficient care and fewer errors.

Emergency Medical Services (EMS) are an added dynamic, as approximately 7%-13% of all EMS calls involve pediatric patients.¹²Training to incorporate all possible caregivers can lead to a more effective team dynamic, and certainly a more accurate clinical pathway.

Additionally, emphasizing closed-loop communication techniques in simulations can not only help to reduce the risk of error, but also increase the speed and efficiency when treating a pediatric patient in crisis.

在每年五岁以下的900万儿童中，据估计，其中70％是由于正确诊断出可以预防或治疗的情况所致。¹⁴Experts recommend concentrating pediatric training efforts on the decision-making process in a clinical pathway, practicing administering medication in small doses required for children, and training with interdisciplinary teams to improve overall communication.

模拟是一种有效的训练方法can incorporate each of these skills. Following a patient case from start to end, with the many ups and downs that a real patient would experience, can enhance existing pediatric training curricula by increasing skills and clinical expertise.¹⁵