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Patient safety is the foundation of high-quality health care. Simulation has been integrated with patient safety activities in pediatric emergency medicine to improve knowledge, skills, and attitudes; teamwork and communication; systems and processes; and identification and mitigation of threats to safety. Simulation efforts, coordinated with those of key stakeholders, can be a powerful agent of change at the individual provider, team, and system levels. It is imperative that simulation activities be integrated within the systems infrastructure for maximal impact and dissemination of learnings. [ABSTRACT FROM AUTHOR]

Study objective: We seek to provide current, comprehensive, and physician-level data for critical procedures performed in a high-volume pediatric emergency department (ED). Methods: We conducted a retrospective study of all critical procedures performed in the ED of a tertiary care pediatric institution. Data were collected from written records of resuscitative care provided. The primary outcome measure was the cumulative frequency of each critical procedure during 12 consecutive months. Additional outcome measures included the number of critical procedures performed by pediatric emergency medicine faculty and fellows and a description of the other physician types performing each procedure. Results: Two hundred sixty-one critical procedures were performed during 194 patient resuscitations, which represented 0.22% of all ED patient evaluations. Sixty-one percent of pediatric emergency medicine faculty did not perform a single critical procedure. Orotracheal intubation occurred 147 times and represented 56% of all critical procedures, yet 63% of pediatric emergency medicine faculty did not perform a single successful orotracheal intubation. Pediatric emergency medicine fellows performed a median of 3 critical procedures. Conclusion: Critical procedures were rarely performed in a large, academic pediatric ED. Pediatric emergency medicine faculty are at significant risk for skill deterioration, and pediatric emergency medicine fellows are unlikely to achieve competence in the performance of critical procedures if clinical exposure is the sole basis for the attainment and maintenance of skill. [Copyright &y& Elsevier]

Study objective: Using video review, we seek to determine the frequencies of first-attempt success and adverse effects during rapid sequence intubation (RSI) in a large, tertiary care, pediatric emergency department (ED). Methods: We conducted a retrospective study of children undergoing RSI in the ED of a pediatric institution. Data were collected from preexisting video and written records of care provided. The primary outcome was successful tracheal intubation on the first attempt at laryngoscopy. The secondary outcome was the occurrence of any adverse effect during RSI, including episodes of physiologic deterioration. We collected time data from the RSI process by using video review. We explored the association between physician type and first-attempt success. Results: We obtained complete records for 114 of 123 (93%) children who underwent RSI in the ED during 12 months. Median age was 2.4 years, and 89 (78%) were medical resuscitations. Of the 114 subjects, 59 (52%) were tracheally intubated on the first attempt. Seventy subjects (61%) had 1 or more adverse effects during RSI; 38 (33%) experienced oxyhemoglobin desaturation and 2 required cardiopulmonary resuscitation after physiologic deterioration. Fewer adverse effects were documented in the written records than were observed on video review. The median time from induction through final endotracheal tube placement was 3 minutes. After adjusting for patient characteristics and illness severity, attending-level providers were 10 times more likely to be successful on the first attempt than all trainees combined. Conclusion: Video review of RSI revealed that first-attempt failure and adverse effects were much more common than previously reported for children in an ED. [Copyright &y& Elsevier]

We report a case of an adolescent male who developed acute-onset, substernal chest pain and was noted to have electrocardiographic changes concerning for inferior and lateral myocardial ischemia. Although adult emergency departments (EDs) manage cardiac chest pain on a daily basis, pediatric EDs have very little experience with chest pain suggestive of myocardial infarction (MI). In addition, MI is being recognized more frequently in the pediatric age group. Historically, evaluation for MI was initiated in the ED but was completed as an inpatient. Recent laboratory and technologic advances have made ruling out MI an ED skill in low-risk patients. It is helpful for pediatric emergency medicine physicians to be aware of current evaluation techniques and their application to at-risk patients. [Copyright &y& Elsevier]

Children with immunosuppression are a high-risk but relatively infrequent presentation to the emergency department. Clinicians need to systematically and efficiently assess these children, especially when they present with fever or potential infectious complaints. Although most are not imminently septic, as the risk of bacteremia leading to sepsis is high, a standardized approach is important to be timely to cover serious pathogens. This case-based review will discuss underlying immune deficiencies in children one might see in the emergency department setting, review the approach to evaluation and acute management, and discuss key issues to minimize morbidity or mortality. [Copyright &y& Elsevier]

Acute care nurse practitioners (ACNPs) require special training and educational preparation to meet their role expectations. Using high fidelity simulation with debriefing modalities is considered one of the innovative learning strategies in graduate nursing. No studies have investigated debriefing modalities in nurse practitioner programs specially ACNPs leadership skills. The purpose of this study was to examine the difference in students' knowledge, code team leader skills and self-efficacy using two debriefing modalities. A two group, pretest-posttest quasi-experimental design was used. Students were divided into video-assisted debriefing group vs. verbal debriefing following a simulation scenario of managing emergency codes. There were no significant differences between the two groups in knowledge acquisition/retention, leadership skills, and self-efficacy, but there was a significant difference in self-efficacy in both groups between two-time points. There was a general improvement in teams' performance. Students preferred verbal debriefing over video-assisted debriefing. The debriefing session plays an important role in graduate nursing education. Acute care nurse practitioners are lacking a formal leadership training to meet their advanced role. Nurse Educators, and simulation/debriefing leaders may benefit from our study results to develop a structured, formal curriculum and educational instruction focusing on acute care nurse practitioners' role change especially leading a resuscitation team. • Simulation and debriefing are important in teaching ACNP leadership skills and self-efficacy. • Both video-assisted debriefing and verbal debriefing are effective in teaching advanced skills. • It is important to examine the impact of debriefing modalities in ACNP students' leadership skills. • ACNPs' advanced role require special leadership skills training and more structured curriculum. • Further studies on debriefing experiences in graduate nursing education are needed. [ABSTRACT FROM AUTHOR]