Airway, Breathing, Confidence!

Background: In the West Midlands (England), paediatric patients may present to either a Paediatric Emergency Department (ED) at a tertiary hospital or a mixed (adult and paediatric) ED at a District General Hospital.

Objective: To assess how confident West Midlands doctors felt in managing paediatric patients in the ED and what could improve confidence.

Method: An online survey was distributed to doctors across West Midlands between the period 21/01/2020 and 03/03/2020.

Results: 94 doctors were surveyed from Emergency (43%), Paediatrics (38%) and Paediatric Emergency (19%) departments.
The majority of Consultants (54%) and Registrars (53%) were very confident 4/5 in managing Paediatric patients. However, most SHOs were somewhat confident 3/5 (51%)
Only Consultants (55%) were very confident 4/5 in managing Paediatric Emergencies, whilst the majority of Registrars (43%) and SHOs (51%) were somewhat confident 3/5. The confidence of each grade for different subspecialties is shown in Graphs 1-3.
Many thought that joint simulation sessions (79%), joint departmental teaching (67%) and tutorial videos (33%) would improve confidence.
Most (72%) working in a mixed ED thought that supported assigned shifts in Paediatric Emergency improved confidence.
40% of those working in a mixed ED thought that the team work between Paediatrics and Emergency was somewhat good-3/5. Whilst some were happy that the paediatric team attended alerts and reviewed patient in ED, there were concerns from both departments about poor communication and team work.
Initiatives already existent that made management go well were Paediatric Emergency Consultant coverage in mixed ED, PILS training, dedicated paediatric resuscitation area and equipment, team debriefing and joint meetings.

Conclusion: Team work, joint teaching and simulation along with allocated time for paediatric emergencies can all improve confidence in managing children in ED. Joint simulation is being arranged at a West Midlands’ hospital where confidence will be assessed before and after sessions.