Just In Time
The key to success in any skill is practice, since practice improves competency. In the pediatric intensive care unit, we do our best to predict and prevent patient decline. However, these events still happen, and sometimes they aren’t preventable. So, how can we ensure that our team is ready to act when it matters the most? We practice.
Step 1 of any effective practice is to identify the areas that need work. We first identify our highest risk patients- those who are most likely to get sicker within the next 24 hours. We then meet with all staff caring for the patient at least every 12 hours and review the plan that the team should enact should the patient worsen. This creates a shared situational awareness among bedside staff.
Step 2 is to execute the plan in a safe environment. We design short simulated scenarios which mirror one of the sickest children in the ICU. In these scenarios, the simulated patient decompensates, as predicted. We then take the ICU staff caring for the patient (e.g., nurses, respiratory therapists, and doctors) and practice the plan that was reviewed earlier in the day.
These just-in-time scenarios gives the ICU team the opportunity to practice caring for our sickest patients, before that care is needed. We practice working together as a team, identify areas of confussion, and adjust our gameplan after trialing it together. We can’t prevent all children from getting sicker, but we can be ready to treat those children when it occurs. How? Practice.
-Danny Loeb, MD, MEd; Kelly Elly RN; Kelly Collins, Matthew Zackoff MD, MEd