602 - Interprofessional Simulation-Based Education for Pediatric Residents on De-escalation of Patients with Mild Agitation

Poster Number: 602
Publication Number: 602.118

Katie Lockwood, Perelman School of Medicine at University of Pennsylvania, Ambler, PA, United States; Katrina Fletcher, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Alyssa R. Rosen, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Dawn DeBrocco, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Christopher Teng, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Adina Freedman, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Gia Yannekis, Children's Hospital of Philadelphia, Philadelphia, PA, United States; AnneMarie Monachino, Children's Hospital of Philadelphia, Aldan, PA, United States; Keith Widmeier, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Erin H. Sieke, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Katherine Donches, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Mary Pipan, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Background: Pediatric residents at our institution have reported discomfort in responding to patients who are agitated in the inpatient setting. With increasing numbers of patients admitted with behavioral and mental health diagnoses, this education gap could put patients and residents at risk. Prior simulations with pediatric residents have focused on moderate-severe agitation, where the resident role is more limited and focused on documentation and order sets. There is a need for resident education in the intern year that highlights a proactive and participatory approach to managing patients at risk for agitation within an inpatient unit with multidisciplinary resources.

Objective: The aim of this resident education program was to develop a simulation-based curriculum to improve pediatric intern comfort and confidence in de-escalating patients with mild agitation, through a short didactic session followed by a Rapid Cycle Deliberate Practice (RCDP) simulation which allowed interns to practice de-escalation skills in a psychologically safe environment, incorporating multiple opportunities to build mastery.

Design/Methods: Pediatric interns (n= 53) were divided into four groups for a 2-hour education session that included one hour of didactic teaching and one hour of simulation experience. In the didactic session, interns were taught triggers and causes of agitation as well as verbal and non-verbal de-escalation strategies. In the simulation session, interns participated in multiple scenarios of mild agitation involving an actor representing an adolescent patient with Autism Spectrum Disorder. RCDP simulation allowed for micro-debriefs with interdisciplinary coaching and education.

Results: A retrospective post-simulation survey was completed by twenty-four (45%) interns. 79.2% reported prior clinical experience de-escalating an agitated or aggressive patient. Results of paired sample t-tests indicate that there were statistically significant increases in both comfort and confidence from before to after the simulation experience (Table 1). 87% reported that the simulation increased their awareness of hospital resources for de-escalation and 100% expect to apply the skills learned to future patient care experiences.Conclusion(s): Interprofessional simulation-based behavioral health education can increase pediatric resident comfort and confidence in de-escalation skills for mild agitation. Future research will examine how the skills learned in this simulation are applied to patient care experiences, and the need for refresher sessions or further training on more moderate to severe agitation.
Intern comfort and confidence in de-escalating patients with mild agitation pre/post simulation.* Comfort/confidence rating scale: 1 not at all; 2 slightly; 3 moderately; 4 very; 5 extremely
** p < 0.05