Evaluación sistemática de la actuación de los pediatras ante un caso simulado de taquicardia supraventricular
- Autores: Ignacio Oulego Erroz, Antonio Rodríguez Núñez, Paula Alonso Quintela, María Mora Matilla, Ana Iglesias Vázquez, Manuel Fernández Sanmartín, Eva Civantos Fuentes, Luis Sánchez Santos
- Localización: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP ), ISSN-e 1696-4608, ISSN 1695-4033, Vol. 77, Nº. 3, 2012, págs. 165-170
- Idioma: español
- Títulos paralelos:
- Systematic assessment of the paediatrician�s performance during simulated
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Resumen
Introduction: The aims of this study are to: a) assess the quality in clinical management during a simulated scenario of acute supraventricular tachycardia (SVT) by means of a structured taskbased checklist and to b) detect pitfalls and grey areas where reinforcement in training may be needed.
Material and methods: We systematically reviewed SVT simulated scenarios during simulation courses between June 2008 and April 2010. Three scenarios were programmed using SimBaby® simulation system, and included stable SVT (S-SVT), stable progressing to unstable SVT (SU-SVT) and unstable SVT (U-SVT). Scenarios were evaluated by means of an 18-task checklist based on ILCOR international recommendations.
Results: A total of 45 scenarios were assessed with the participation of 167 paediatricians, including 15 S-SVT, 25 SU-SVT and 5 U-SVT scenarios. Out of a total of 551 possible tasks, 328 (59.5%) were completed correctly. The mean percentage of correct tasks per scenario was 63.4 (16.7) for S-SVT, 47.8 (20.3) for SU-ST and 38.6 (31) for U-SVT (p = 0.028). There were no signi?cant differences between primary care paediatricians and hospital paediatricians. Most of the participants correctly identi?ed non-sinus rhythm as SVT. However, important pitfalls were observed, including failure to identify haemodynamic instability in 20 out of 43 (48%) cases, an incorrect dose of adenosine in 18 out of 39 (48%), incorrect adenosine administration in 23 out of 39 (59%), and non-recognition of indication to emergent cardioversion in 15 out of 31 (48%).
Conclusions: Paediatricians are able to diagnose SVT correctly, but need to improve their skills in treatment. Systematic analysis of clinical performance in a simulated scenario allows the identi?cation of strengths, as well as weak points, where reinforcement is needed.
