Imitation can be a mechanism for updating new medical guidelines for COVID-19

Imitation can be an operational way to quickly evaluate and update new medical guidelines and educate hospital staff in new methods, a recent study from UT Southwestern Department of Pediatrics shows. The findings, recently published in the journal Pediatric Quality and Safety and initially shaped around new pediatric rehabilitation methods related to COVID-19 at UTSW and Child Health, they could eventually be used to help implement other types of instructions at medical centers across the country.

For decades, U.S. hospitals have used the same standard procedures for CPR and intubation. But with the outbreak of COVID-19 pandemic disease early last year, some details about these procedures needed to be changed, explains Blake E. Nichols, MD, professor of child support at UTSW and physician Emergency at Children’s Health.

CPR and intubation are among procedures with the highest risk of transmitting SARS-CoV-2, the virus that causes COVID-19, to health care workers. To help protect hospital staff, the American Heart Association (AHA) and the Society for Critical Care Medicine (SCCM) published recommendations in April 2020 for performing these procedures in the safest way possible. on patients who are either positive for COVID-19 or suspected of having the virus.

Because severely ill children with COVID-19 make up just a fraction of the patient population, relapse gratefully is a rare event, Nichols said. But this rarity also makes it more difficult to create practical guidance around these situations and educate hundreds of staff who may be involved in these procedures at hospitals.

To evaluate best practices, Nichols and his colleagues simulated using protocols that differ from the typical simulation events used for CPR or intubation training. The researchers began with new guidelines written by the UTSW / Child Health committee based on the recommendations of the AHA and SCCM. There were significant differences in that direction from the usual rehabilitation procedures, including the inclusion of a medical team with much fewer members, ensuring that all members are fully secure. in personal protective equipment (PPE) before entering the patient’s room, and ensuring that the patient is closed in volume. protective gear as possible to prevent the spread of infectious germs.

Nichols brought together a team of six to take part in a recovery event. The team included pediatric intensive care physicians, nurses, respiratory therapists, and a writer from the steering committee.

The team tested the lead in two different scenarios: In one, a patient mocked under the guise of plastic equipment that was repositioned as a protective shield, proving its utility for protecting health care workers during intubation and CPR and determining how they could protect the shield around the patient for the best results. In another, the team performed a symbolic intubation and CPR on a mannequin in a negative pressure room, with some team members outside the room passing equipment and medications and others actively handling the patient with a symbol.

During the four-hour event, the team used rapid cycling exercise (RCDP), an established medical simulation technique that allows the exercise to be stopped at any time to improve directions or correct errors. But unlike a standard RCDP – in which only one member acts as an expert and is in charge of stopping the simulation for corrections – in this case each member of the team was considered an expert, allowing each insert, make quick changes, and hone. the direction. The simulation was recorded to create an educational video for other hospital staff.

Nichols says the team identified a number of problems with the proposed guidelines for UTSW / Child Health. For example, the team found that two nurses were needed at the patient ‘s bedside during recovery – rather than just one as recommended in the guidelines – to prevent overwork. In addition, communication needed to be improved as the PPE prevented team members from seeing facial expressions or listening commands as they normally would.

The video was used to educate nearly 300 employees at UTSW and Children ‘s Health about the new guidelines within a few days, allowing for rapid dissemination, Nichols says. The whole process – from writing the guide to distributing the video – took less than two weeks. He identified this as a very rapid reversal that the pandemic needed.

The COVID-19 pandemic prompted us to find new ways to provide the best possible care for our patients while protecting and educating health care workers. on new methods. We have shown that imitation provides an excellent opportunity to achieve this goal. “

Blake E. Nichols, MD, Associate Professor of Pediatrics, UTSW