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Patient Safety and Quality Improvement

Novel Mobile Application for Assessing Pediatric Tracheostomy Emergency Simulations

Monday, October 2, 2023
4:39 PM - 4:45 PM East Coast USA Time
Location: 202A

    Presenting Author(s)

  • ES

    Elliot Schiff, BA

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

    • Co-Author(s)

  • ES

    Elliot Schiff, BA

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

    • Presenting Author(s)

  • Marc-Mina N. Tawfik, BS

    Medical Student
    Albert Einstein College of Medicine
    Bronx, NY, United States

    • Co-Author(s)

  • Marc-Mina N. Tawfik, BS

    Medical Student
    Albert Einstein College of Medicine
    Bronx, NY, United States

  • Regine M. Fortunov, MD

    Associate Professor of Pediatrics
    Baylor College of Medicine
    Houston, TX, United States

  • JL

    Jianyou Liu, M.S.

    Albert Einstein College of Medicine, Department of Epidemiology and Population Health, USA

  • AN

    Akira Nishisaki, MD, MSCE

    Associate Professor, Anesthesiology, Critical Care and Pediatrics
    The Children’s Hospital of Philadelphia
    Philadelphia, PA, United States

  • TM

    Tensing Maa, MD

    Professor of Clinical Pediatrics
    Nationwide Children’s Hospital
    Columbus, OH, United States

    • Senior Author(s)

  • Christina J. Yang, MD

    Associate Professor
    Montefiore Medical Center / Albert Einstein College of Medicine
    Bronx, NY, United States

Disclosure(s):
Elliot Schiff, BA: No relevant relationships to disclose.
Marc-Mina N. Tawfik, BS: No relevant relationships to disclose.
Christina J. Yang, MD: No relevant relationships to disclose.
Introduction: Tracheostomy emergencies are low-frequency, high-risk events in pediatric inpatient care. Quantification of emergency readiness is necessary for effective assessment of preparedness for these acute clinical events. Whereas current models rely on video-review to assess performance following in-situ simulation, there are limited ways to efficiently score participants during simulations.

Methods: Two independent raters used the novel mobile application NeoCHART+ TM for PEAK to score video-recorded tracheostomy emergency in-situ simulations from across the Montefiore Medical Center system. For each simulation, results were compared to ratings obtained from manual review of these videos. Following an initial review of 5 simulations, data definitions of component steps in the app were refined to mitigate ambiguity. Next, 5 unique simulation video recordings were reviewed, again manually and with the app. For this second round, intra-rater and inter-rater reliability were calculated by percent agreement. A time-stamp difference ≤5 seconds was considered agreement. Disagreement was defined as omission of an item or a time-stamp difference >5 seconds.

Results: Manual review of 5 videos showed 89.7% agreement between the 2 reviewers, vs. 96.4% for app review. Rater 1 had 100% agreement between manual and app review of videos, and rater 2 had 89.7% agreement.

Conclusions: This mobile app can establish time-stamps of key components of the pediatric tracheostomy emergency clinical algorithm as they occur, thus allowing for automated analysis and straightforward comparison of hospital teams across both temporal and geographic space. This app-based model can be refined further and adapted to other simulation-based assessment tools in multiple specialties. Future directions include increasing sample size and number of raters, and establishing acceptability and ease of use during real-time in-situ simulations.