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Just In Time

It’s third down. Joe Burrow steps back in the pocket. He looks left, the wide receiver is covered. A defensive tackle barrels down the middle of the pocket. Joe rolls right, steps back, and launches the ball 40 yards. Ja’Marr Chase is sprinting down the field, an orange blur. He leaps up and catches the ball with one hand and falls into the endzone. Touchdown! The stadium… is silent. No applause, no claps, nothing. Why? It’s practice- no one is watching.

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

Just In Time
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