Nurse-Initiated Treatment Reduces Costs for Acute Asthma in a Pediatric Emergency Department

Standardized emergency department (ED) pathways can improve care delivery to children with acute asthma, though their impact on hospitalization and costs is unclear. An Acute Asthma Care Pathway (AACP) that facilitates nurse initiation of treatment was implemented at a tertiary care pediatric ED using standard quality improvement methodology. The impact of implementation was assessed using process control methodology and multivariable time series analyses between pre- and post-implementation periods. Provision of a steroid within 30 minutes and 60 minutes of arrival increased by 21 and 22 percentage points respectively, IV magnesium sulfate administration increased by 30 percentage points, the proportion hospitalized decreased from 44.8% to 32.2%, and mean direct costs per patient decreased from $2,663 to$2,303 (13.5%). In multivariable analysis, these improvements remained significant. Implementation of the AACP improved timeliness of treatment, hospitalization, and direct costs of children receiving ED treatment for acute asthma

Client Centered Simulation: Practicing Interprofessional Teamwork with Standardized Patients

Background Interprofessional education (IPE) prepares students to work in collaborative teams (Burin et al., 2009). Educators use a variety of methods to develop and enhance teamwork skills (Fox et al., 2018). Standardized patient (SP) simulations allow students to practice skills in safe environments (Herge et al., 2013) and respond to situations as they would under natural conditions (McGaghie, 1999). As an active learning experience, SP simulations help students break through the “illusion of understanding” (Syinicki & McKeachie, 2001 p. 190). Kirkpatrick posits a hierarchy of changes as a result of training/education (Kirkpatric, 1979). At the highest level is transfer of learning to change behavior. Assessment of IPE influenced behavior change is limited and most assessments measure satisfaction, attitudes and knowledge (Abu-Rish et al., 2012). Team Care Planning is a simulated discharge meeting with an elderly female patient who had a CVA and her adult daughter played by standardized patients. It was developed in 2009 as Clinical Discharge Scenario as part of a Geriatric Education Center grant. Goals for this learning activity are: Health care professions students will: identify roles and responsibilities of professionals on the healthcare team and practice communication and collaboration in an interprofessional team simulation