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ALERT Presentation:
Improving trainee success rates
with Infant Lumbar Puncture

David Kessler, et al.
Columbia University, NY
INSPIRE @ IMSH 2014: San Francisco, California,USA
International Network for Simulation-based Pediatric Innovation, Research and Education
2012

44 hospitals
1008 trainees
2013-14 Collaborators
•
•
•
•
•
•
•
•
•

Jennifer Trainor
Daniel Lemke
Louisdon Pierre
Daniel Fein
Kathleen Ostrom
Megan Lavoie
Brett McAninch
Joel Clingenpeel
Pavan Zaveri

Denis Oriot
James Gerard
Devin Grossman
Moon Lee E.
Berry Seelbach
Amanda Pratt
Rita Dadiz
Jonathan Jacobs
Kevin Ching
Marc Auerbach

Marjorie Lee White
Wendy Van Ittersum
Joshua Rocker
Lisa McQueen
Sujit Iyer
Brian Costello
Renuka Mehta
Maybelle Kou
DJ Scherzer
Cena Tejani
Elsa L Vazquez Melendez
2013-14 Collaborators
Columbia
Yale University
Comer Children's Hospital
Nationwide Children's Hospital
Stony Brook University
Inova Fairfax Hospital for Children
UMDNJ/RWJUH
Children's Hospital at Montefiore
Children's Hospital Los Angeles
Cleveland Clinic
Weill Cornell Medical Center
Centre Hospitalier de Poitiers
Georgia Health Sciences University
King Abdulaziz University Hospital
University of Rochester Medical Center
Children's Hospital of Pittsburgh of UPMC
Cohen Childrens medical Center
Children's National Medical Center

University of Wisconsin
Children's of Alabama
LeBonheur Children's Hospital
UTSW
Jacobi Medical Center
OSF Saint Francis Medical Center/University of
Illinois College of Medicine at Peoria
Alfred I dupont
Children’s Hospital of the Kings Daughters
Brooklyn Hospital Center
Ann & Robert H. Lurie Children's Hospital of
Chicago
Dell Children's Medical Center of Central Texas
Emory
CHOP
Tufts Medical Center/Floating Hospital for
Children at Tufts Medical Center
SSM Cardinal Glennon Children's Medical
Center/SLU
Background
Design
2008

Single center RCT in all peds residents n=56

•Sim-training vs video here
Add text
2009

Multi-center RCT (10) n=200

Outcomes

Results

Successful LP,
94% vs 47%
confidence,
knowledge, skills
on simulator
Successful LP or 34% vs 34%
IV

Sim LP vs Sim IV
2010

Multi-center cohort (25) n= 501
Sim LP mastery & JIT vs historical

Successful LP

42% vs 34%

2011

Multi-center cohort (33) n=700
Sim LP mastery, JIT and assessed

Successful LP

Competent 55% Incompetent
28%

2012

Multi-center cohort (38) n=1000
Competency pathway vs none

Successful LP

pathway vs no pathway

2013

Multi-center cohort (35) n=990
Competency pathway vs none

Successful LP

pathway vs no pathway

International Network for Simulation-based Pediatric Innovation, Research and Education
1.
Online
Survey &
Audiovisual
Training

3.
JIT:
Just-in-time
Refresher
Session

2.
Mastery
Learning
Session

Orientation

July

August

4.
Clinical
Lumbar
Puncture

September

4.
JIT:
Just-in-time
Refresher
Session
October

November

5.
Clinical
Lumbar
Puncture

December
Academic Productivity
MANUSCRIPTS

JOURNAL

PI

A Randomized Trial of Simulation-Based Deliberate
Practice For Infant Lumbar Puncture Skills.
Simulation in Healthcare

SIH
2011

Kessler

Infant Lumbar Puncture: POISE Pediatric Procedure
Video.

MedEdPORAL
2011

Interns' Success With Clinical Procedures in Infants
After Simulation Training

Pediatrics
2013

Kessler

Validation of Global Rating Scale and Checklist
Instruments for the Infant Lumbar Puncture
Procedure.

SIH
2013

Gerard

Are pediatric interns prepared to perform infant
lumbar punctures? A multi-institutional descriptive
study.

PEC
2013

Auerbach

Qualitative evaluation of just-in-time simulationbased learning: The learners' perspective.

SIH
2013

Kamdar

Auerbach
Works in Progress
MANUSCRIPTS IN PROGRESS (S=submitted)

PI

Competency assessment scale predicts success

Auerbach

Just-in-time refreshers impact on LP clinical success S

Kessler

Competency assessment HARD STOP – impact on success

Kessler

Description of 3rd year success rates

Marjorie

Barriers to implementation of competency pathway - qualitative

Dadiz

Impact of sim JIT on analgesia use for infant LP

Fein

Emergency medicine resident sub-analysis

Grossma
n

Barriers to JIT/workplace learning perceived by instructors-qualitative S

Kamdar

Resident JIT impact on ILP success

Zaveri
3 Questions to improve study
1. Grant ideas?
2. LP ipad app – in development

3. Current plan: take a year off data
collection to let the soil lay “fallow”

International Network for Simulation-based Pediatric Innovation, Research and Education
Contact Information
Name: David Kessler
Institution: CHONY

dk2592@columbia.edu, 5167693777

International Network for Simulation-based Pediatric Innovation, Research and Education

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Kessler lp alert update 2014

  • 1. ALERT Presentation: Improving trainee success rates with Infant Lumbar Puncture David Kessler, et al. Columbia University, NY INSPIRE @ IMSH 2014: San Francisco, California,USA International Network for Simulation-based Pediatric Innovation, Research and Education
  • 3. 2013-14 Collaborators • • • • • • • • • Jennifer Trainor Daniel Lemke Louisdon Pierre Daniel Fein Kathleen Ostrom Megan Lavoie Brett McAninch Joel Clingenpeel Pavan Zaveri Denis Oriot James Gerard Devin Grossman Moon Lee E. Berry Seelbach Amanda Pratt Rita Dadiz Jonathan Jacobs Kevin Ching Marc Auerbach Marjorie Lee White Wendy Van Ittersum Joshua Rocker Lisa McQueen Sujit Iyer Brian Costello Renuka Mehta Maybelle Kou DJ Scherzer Cena Tejani Elsa L Vazquez Melendez
  • 4. 2013-14 Collaborators Columbia Yale University Comer Children's Hospital Nationwide Children's Hospital Stony Brook University Inova Fairfax Hospital for Children UMDNJ/RWJUH Children's Hospital at Montefiore Children's Hospital Los Angeles Cleveland Clinic Weill Cornell Medical Center Centre Hospitalier de Poitiers Georgia Health Sciences University King Abdulaziz University Hospital University of Rochester Medical Center Children's Hospital of Pittsburgh of UPMC Cohen Childrens medical Center Children's National Medical Center University of Wisconsin Children's of Alabama LeBonheur Children's Hospital UTSW Jacobi Medical Center OSF Saint Francis Medical Center/University of Illinois College of Medicine at Peoria Alfred I dupont Children’s Hospital of the Kings Daughters Brooklyn Hospital Center Ann & Robert H. Lurie Children's Hospital of Chicago Dell Children's Medical Center of Central Texas Emory CHOP Tufts Medical Center/Floating Hospital for Children at Tufts Medical Center SSM Cardinal Glennon Children's Medical Center/SLU
  • 5. Background Design 2008 Single center RCT in all peds residents n=56 •Sim-training vs video here Add text 2009 Multi-center RCT (10) n=200 Outcomes Results Successful LP, 94% vs 47% confidence, knowledge, skills on simulator Successful LP or 34% vs 34% IV Sim LP vs Sim IV 2010 Multi-center cohort (25) n= 501 Sim LP mastery & JIT vs historical Successful LP 42% vs 34% 2011 Multi-center cohort (33) n=700 Sim LP mastery, JIT and assessed Successful LP Competent 55% Incompetent 28% 2012 Multi-center cohort (38) n=1000 Competency pathway vs none Successful LP pathway vs no pathway 2013 Multi-center cohort (35) n=990 Competency pathway vs none Successful LP pathway vs no pathway International Network for Simulation-based Pediatric Innovation, Research and Education
  • 7. Academic Productivity MANUSCRIPTS JOURNAL PI A Randomized Trial of Simulation-Based Deliberate Practice For Infant Lumbar Puncture Skills. Simulation in Healthcare SIH 2011 Kessler Infant Lumbar Puncture: POISE Pediatric Procedure Video. MedEdPORAL 2011 Interns' Success With Clinical Procedures in Infants After Simulation Training Pediatrics 2013 Kessler Validation of Global Rating Scale and Checklist Instruments for the Infant Lumbar Puncture Procedure. SIH 2013 Gerard Are pediatric interns prepared to perform infant lumbar punctures? A multi-institutional descriptive study. PEC 2013 Auerbach Qualitative evaluation of just-in-time simulationbased learning: The learners' perspective. SIH 2013 Kamdar Auerbach
  • 8. Works in Progress MANUSCRIPTS IN PROGRESS (S=submitted) PI Competency assessment scale predicts success Auerbach Just-in-time refreshers impact on LP clinical success S Kessler Competency assessment HARD STOP – impact on success Kessler Description of 3rd year success rates Marjorie Barriers to implementation of competency pathway - qualitative Dadiz Impact of sim JIT on analgesia use for infant LP Fein Emergency medicine resident sub-analysis Grossma n Barriers to JIT/workplace learning perceived by instructors-qualitative S Kamdar Resident JIT impact on ILP success Zaveri
  • 9. 3 Questions to improve study 1. Grant ideas? 2. LP ipad app – in development 3. Current plan: take a year off data collection to let the soil lay “fallow” International Network for Simulation-based Pediatric Innovation, Research and Education
  • 10. Contact Information Name: David Kessler Institution: CHONY dk2592@columbia.edu, 5167693777 International Network for Simulation-based Pediatric Innovation, Research and Education