Browsing by Author "Auerbach, Marc"

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    Debriefing Techniques Utilized in Medical Simulation
    (StatPearls Publishing, 2023-01) Abulebda, Kamal; Auerbach, Marc; Limaiem, Faten; Pediatrics, School of Medicine
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    Emergency Department Pediatric Readiness Among US Trauma Centers: A Machine Learning Analysis of Components Associated with Survival
    (Wolters Kluwer, 2023) Newgard, Craig D.; Babcock, Sean R.; Song, Xubo; Remick, Katherine E.; Gausche-Hill, Marianne; Lin, Amber; Malveau, Susan; Mann, N. Clay; Nathens, Avery B.; Cook, Jennifer N. B.; Jenkins, Peter C.; Burd, Randall S.; Hewes, Hilary A.; Glass, Nina E.; Jensen, Aaron R.; Fallat, Mary E.; Ames, Stefanie G.; Salvi, Apoorva; McConnell, K. John; Ford, Rachel; Auerbach, Marc; Bailey, Jessica; Riddick, Tyne A.; Xin, Haichang; Kuppermann, Nathan; Pediatric Readiness Study Group; Surgery, School of Medicine
    Objective: We used machine learning to identify the highest impact components of emergency department (ED) pediatric readiness for predicting in-hospital survival among children cared for in US trauma centers. Background: ED pediatric readiness is associated with improved short-term and long-term survival among injured children and part of the national verification criteria for US trauma centers. However, the components of ED pediatric readiness most predictive of survival are unknown. Methods: This was a retrospective cohort study of injured children below 18 years treated in 458 trauma centers from January 1, 2012, through December 31, 2017, matched to the 2013 National ED Pediatric Readiness Assessment and the American Hospital Association survey. We used machine learning to analyze 265 potential predictors of survival, including 152 ED readiness variables, 29 patient variables, and 84 ED-level and hospital-level variables. The primary outcome was in-hospital survival. Results: There were 274,756 injured children, including 4585 (1.7%) who died. Nine ED pediatric readiness components were associated with the greatest increase in survival: policy for mental health care (+8.8% change in survival), policy for patient assessment (+7.5%), specific respiratory equipment (+7.2%), policy for reduced-dose radiation imaging (+7.0%), physician competency evaluations (+4.9%), recording weight in kilograms (+3.2%), life support courses for nursing (+1.0%-2.5%), and policy on pediatric triage (+2.5%). There was a 268% improvement in survival when the 5 highest impact components were present. Conclusions: ED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.
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    Impact of Individual Components of Emergency Department Pediatric Readiness on Pediatric Mortality in US Trauma Centers
    (Wolters Kluwer, 2023) Remick, Katherine; Smith, McKenna; Newgard, Craig D.; Lin, Amber; Hewes, Hilary; Jensen, Aaron R.; Glass, Nina; Ford, Rachel; Ames, Stefanie; Cook, Jenny; Malveau, Susan; Dai, Mengtao; Auerbach, Marc; Jenkins, Peter; Gausche-Hill, Marianne; Fallat, Mary; Kuppermann, Nathan; Mann, N. Clay; Surgery, School of Medicine
    Background: Injured children initially treated at trauma centers with high emergency department (ED) pediatric readiness have improved survival. Centers with limited resources may not be able to address all pediatric readiness deficiencies, and there currently is no evidence-based guidance for prioritizing different components of readiness. The objective of this study was to identify individual components of ED pediatric readiness associated with better-than-expected survival in US trauma centers to aid in the allocation of resources targeted at improving pediatric readiness. Methods: This cohort study of US trauma centers used the National Trauma Data Bank (2012-2017) matched to the 2013 National Pediatric Readiness Project assessment. Adult and pediatric centers treating at least 50 injured children (younger than 18 years) and recording at least one death during the 6-year study period were included. Using a standardized risk-adjustment model for trauma, we calculated the observed-to-expected mortality ratio for each trauma center. We used bivariate analyses and multivariable linear regression to assess for associations between individual components of ED pediatric readiness and better-than-expected survival. Results: Among 555 trauma centers, the observed-to-expected mortality ratios ranged from 0.07 to 4.17 (interquartile range, 0.93-1.14). Unadjusted analyses of 23 components of ED pediatric readiness showed that trauma centers with better-than-expected survival were more likely to have a validated pediatric triage tool, comprehensive quality improvement processes, a pediatric-specific disaster plan, and critical airway and resuscitation equipment (all p < 0.03). The multivariable analysis demonstrated that trauma centers with both a physician and a nurse pediatric emergency care coordinator had better-than-expected survival, but this association weakened after accounting for trauma center level. Child maltreatment policies were associated with lower-than-expected survival, particularly in Levels III to V trauma centers. Conclusion: Specific components of ED pediatric readiness were associated with pediatric survival among US trauma centers.
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    Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study
    (Elsevier, 2020-04) Maa, Tensing; Scherzer, Daniel; Harwayne-Gidansky, Ilana; Capua, Tali; Kessler, David O.; Trainor, Jennifer L.; Jani, Priti; Damazo, Becky; Abulebda, Kamal; Diaz, Maria Carmen G.; Sharara-Chami, Rana; Srinivasan, Sushant; Zurca, Adrian; Deutsch, Ellen S.; Hunt, Elizabeth A.; Auerbach, Marc; Pediatrics, School of Medicine
    Background Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported. Objective To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. Methods A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected. Results Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid. Conclusions A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites.
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    Using Simulation to Measure and Improve Pediatric Primary Care Offices Emergency Readiness
    (Wolters Kluwer, 2020-06) Garrow, Amanda L.; Zaveri, Pavan; Yuknis, Matthew; Abulebda, Kamal; Auerbach, Marc; Thomas, Eileen M.; Pediatrics, School of Medicine
    Introduction Emergencies in the pediatric primary care office are high-risk, low-frequency events that offices may be ill-prepared to manage. We developed an intervention to improve pediatric primary care office emergency preparedness involving a baseline measurement, a customized report out with action plans for improvement (based on baseline measures), and a plan to repeat measurement at 6 months. This article reports on the baseline measurement. Methods This baseline measurement consisted of 2 components: preparedness checklists and in situ simulations. The preparedness checklists were completed in person to measure compliance with the American Academy of Pediatrics Policy Statement: preparation for emergencies in the offices of pediatricians and pediatric primary care providers, in the domains of equipment, supplies, medication, and guidelines. Two in situ simulations, a child in respiratory distress and a child with a seizure, were conducted with the offices' interprofessional teams; performance was scored using checklists. Results Baseline measurements were conducted in 12 pediatric offices from October to December 2018. Wide variability was noted for compliance with the American Academy of Pediatrics recommendations (range = 47%–87%) and performance during in situ simulations (range = 43%–100%). Conclusions Pediatric primary care office emergency preparedness was found to be variable. Simulation can be used to augment existing measures of emergency preparedness, such as checklists. By using simulation to measure office emergency preparedness, areas of knowledge deficit and latent safety threats were identified and are being addressed through ongoing collaboration.