Adhärenz zu pädiatrischen Reanimationsleitlinien sechs Monate sowie ein Jahr nach stattgehabtem Inhouse-Simulationstraining an hessischen Kinderkliniken

This study examined long-term effects of structured pediatric simulation training for interprofessional pediatric teams on guideline adherence at six and twelve months. In addition, the effect of structural characteristics of team leaders on guideline adherence was evaluated. This was a multicenter, prospective intervention study at ten pediatric hospitals in Hesse, Germany, which took place between January and December 2018. A total of 112 physicians and nurses in 42 teams were studied. Six months (t1) and twelve months (t2) after a two-day simulation-based pediatric resuscitation training, performance was assessed again using a test scenario. Some of the participants were followed up at both six and twelve months (T2a), and some were followed up at twelve months only (T2b). The simulation scenarios were standardized and treated a critically ill child with consecutive cardiovascular arrest and shockable rhythm. Guideline adherence was assessed using a validated Performance Evaluation Checklist. In addition, time-critical key skills in pediatric emergency care were examined. The study scenarios were captured via audio-video system and were randomized and blinded before evaluation. The study showed declining resuscitation skills and guideline adherence in the months after initial simulation training when participants were followed up only once. This decline in performance was independent of whether the first follow-up was at six or twelve months: Frequency of chest compressions (T0post (100%); T1 (85.7%); T0post (100%); T2b (85.7%)), time to chest compressions, frequency of administration of epinephrine, correctness of administration of amiodarone. The collected data related to defibrillation as well as overall performance pointed in the same direction but failed at the significance level. The decline in competence occurred mainly in the first six months and did not deteriorate significantly further without intervention over the course of another six months. Our study highlights that at a second follow-up after twelve months, no difference from the post-training level was demonstrated, especially in terms of chest compressions and medication administration. Similar trends were evident with respect to overall performance and defibrillation. The study thus demonstrates that an examination scenario with debriefing after six months had an effect on competence retention after twelve months in the sense of a booster intervention. This booster effect of the follow-up examination was not originally intended. In contrast, the described decline in competence remained detectable when teams did not undergo this scenario. The effect that the described decline was not detectable after twelve months when teams had undergone a scenario with debriefing after six months may be due to the additional repetition, debriefing, and the effect of spaced testing. While studies have already demonstrated the effect of regular (e.g., monthly) repetition on the quality of individual procedural skills, our study shows that this also promotes longer-term skill retention. Our study points out that a resuscitation scenario with subsequent structured debriefing appears to be a resource-efficient measure to ensure a certain level of competence maintenance with manageable effort. It is desirable to design the refreshing scenario as a maintenance or booster strategy, that is, to provide the scenario before the onset of a decline in performance to pre-training levels. This would promote long-term skill retention. We did see a measurable training effect in individual competencies such as recognition of cardiovascular arrest and chest compressions. These competencies were also maintained up to twelve months post-training as a result of participating in the six-month scenario. However, our results also highlight areas where additional practice in the initial training appears necessary: in terms of overall performance and in defibrillation we see only moderate overall team competencies at follow-up. There were deficiencies in rhythm recognition and in the proceeding when rhythm was shockable. This illustrates that individual competencies (e.g. rhythm recognition, amiodarone administration) must be trained more intensely even initially and should also be emphasized in the debriefing after a possible time-delayed scenario. There is also a need for training to further shorten the time to initiation of all key skills. Our study results demonstrate the professional status of the team leader correlates with change in guideline adherence: Resident-led teams showed more significant performance gains in global guideline adherence between first and second follow-up than senior-led teams. Thus, an additional scenario is particularly effective for this subgroup, whereas more effective strategies need to be found for senior physician team leaders. Further larger-scale studies need to follow to confirm the results and optimize the training format.