Two years ago, the Children’s of Alabama Community Healthcare Education Simulation Program, or COACHES, launched with a mission of improving pediatric care in community hospitals throughout Alabama.
The COACHES team has logged nearly 30 visits to emergency departments or pediatric inpatient units since the program’s inception. These visits include assessments related to pediatric readiness and simulation training on pediatric-specific illnesses. Community EDs are usually initial care providers for pediatric patients, and up to 90 percent of critically ill pediatric patients will not receive initial care at a pediatric trauma center such as Children’s. Very few community hospitals have the resources or access to a provider with significant experience in caring for critically ill children.
Pediatric patient management error rates at community hospitals have been reported to be as high as 64 percent, and rural physicians have reported a greater need for CME regarding pediatric emergency procedures. Children’s receives 36 percent of children from community hospitals, while the national average is 26 percent. It is vital that community hospitals are experienced when taking care of sick children to ensure they have appropriate, time-sensitive treatment.
When we began planning the COACHES Program, we often asked ourselves how we could help community hospitals without just criticizing their management from our ivory tower. We found the answer to be simulation, which uses technology to recreate real-life scenarios, including the care of critically ill children. Studies have shown simulation-based educational programs can improve provider skills and patient outcomes while reducing errors. It also strengthens the relationships between specialty groups and community health providers through outreach simulation programs.
The COACHES Program, which is offered free of charge to community hospitals, includes two separate three-hour simulation sessions. Four real-life scenarios are conducted during each session.
For each scenario, a medical management checklist, including national care guidelines, is used to evaluate hospital health care team performance. Team communication is evaluated using a validated tool.
Each simulation scenario is followed by a debriefing with team members. The debriefing focuses on positive aspects of medical management, improvement opportunities, communication and barriers to patient care, including suggestions to overcome them. A report including the results of the survey as well as the overall performance score for both sessions is presented to each hospital. The report also details how well each hospital performed compared to Children’s performance standard. Any latent safety issues are also identified with a proposed plan for improvement.
Though simulation is the core of the COACHES Program, our communication with providers doesn’t end there. We offer feedback about real patients who were transferred to Children’s, and assist hospitals in developing policies and acquiring pediatric supplies. Our goal is to better equip hospitals with the tools needed to ensure quality of care for children, and that is a win-win for all parties involved, most importantly the children of Alabama.
For more information, visit childrensal.org/coaches or email COACHES@childrensal.org.
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