PEPP simulation in action
By: Shiela Olley, Senior Communications Consultant
In 2022/23, Halton Healthcare started seeing historically high volumes of paediatric patients presenting in its emergency departments at Georgetown Hospital, Milton District Hospital and Oakville Trafalgar Memorial Hospital -- about 40,000 children in a period of 12 months which is an increase of 15-20 per cent. Some experts believe the surge, echoed at other hospitals across the province, is the result of an 'immunity debt' caused by isolation during the COVID pandemic. Because children were not exposed to seasonal viruses as much as usual, their antibodies are lower, creating greater susceptibility to illnesses such as bronchiolitis, pneumonia, respiratory syncytial virus (RSV) and asthma.
This surge is expected to last two to three years with even higher volumes and acuity during the winter months. To prepare for that, paediatric leaders at Halton Healthcare developed an innovative training model called the PEPP Squad – a Paediatric Emergency Practice Partnership to upskill emergency department (ED) staff and physicians in the unique needs of young children.
Dr. Jonathan Sam, Chief of Pediatrics at Oakville and Georgetown Hospitals, says, “When caring for children, the stakes are high. We identified that some of the most important work existed in the gap between departments. We wanted to give our ED staff and physicians the training and confidence to respond more quickly and effectively to the unique needs of kids and their families."
An expert team of ED/Paediatric Professional Practice Clinicians, paediatric/ED nurses, Chief of Paediatrics, Child Life Specialist, Registered Dietitian, and Respiratory Therapists developed teaching materials and offers skills workshops and just-in-time teaching at the bedside.
“It has been truly amazing to see how much of a difference it can make when we can provide support proactively, such as using a numbing cream, facilitating a cuddle with a parent, and offering distraction during a procedure," says Jocelyn Leworthy, Child Life Specialist. “Taking simple, child friendly steps can completely change a child's perception of their healthcare experience." As one emergency department nurse says, “The Child Life Specialist worked with me on a shift and brought toys for the patient and helped settle them prior to an IV insertion. She also shared tips on inclusive language with me. It really seemed to help my patient."
The PEPP simulations use a PEARLS framework – Promoting Excellence And Reflective Learning in Simulation – which is the gold standard for experiential learning by healthcare professionals. The in-situ ED scenario-based simulations provide a safe, supportive environment for hands-on training with mannequins. These simulations teach optimal communication and defined roles for a high-functioning acute care team, initial assessments, responding to abnormal vital signs, and timely interventions.
To exponentially increase the number and impact of these simulations, the program leaders created a series of Train-the-Trainer workshops, bringing nursing and physician leaders together to form teaching dyads who then train their own teams at their local hospital. The team of trainers meet monthly, change the shared case-of-the-month, practice running the new case, and hone their debriefing skills, which allows learners to reflect, ask questions and discuss outcomes.
These dyads also role model Halton Healthcare's expectation of interprofessional collaboration, communication and positive mutual regard between professions.
The response from staff and physicians is overwhelmingly positive with 15-30 participants per simulation session, and many repeat participants. Cheryl Hoare, Director of the Maternal Child program at Oakville Trafalgar Memorial Hospital and Cardiorespiratory & Neurodiagnostics at Halton Healthcare, recognizes this innovative education approach. “The PEPP Program Development Team exceeded our expectations. They have taken their vision through to successful implementation because of their ability to engage with and guide passionate clinical experts across programs and hospital sites. Their multimodal approach has worked within the fast-paced ED environment, advancing the hospital's vision of exemplary patient experiences always."