Putting fear aside to help care for kids

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With little time to prepare, Riley PICU set up a simulation room to train nurses, respiratory therapists and physicians how best to care for COVID-19 patients.


By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org

Dr. Riad Lutfi and his colleagues in the pediatric intensive care unit at Riley Hospital for Children at IU Health saw the signs all around them.

They knew the COVID-19 crisis would be at their doorstep sooner rather than later, and they were determined to be as ready as they could be.

Yes, the virus attacks the adult population hardest, but pediatric patients would undoubtedly be hit as well, and, as the largest children’s hospital in the state, Riley needed to be ready.

That’s why, about three weeks ago, the PICU set aside a simulation room on the seventh floor of Riley to train team members to care for COVID-19 patients.

The room has everything a team would need to treat a patient – all of the supplies, machines and equipment. The only thing not real is the patient. It’s a high-tech, child-size mannequin that gives doctors, nurses and respiratory therapists the chance to practice the specialized treatment required in a way that keeps patients and team members as safe as possible.

“A lot of children’s hospitals may be behind, saying this is an adult disease,” Dr. Lutfi said. “We did not take this approach, and I’m glad we didn’t. I think this simulation program moved us from being scared of the unknown, the unseen enemy, to actually being prepared and working together and protecting each other and the patients within just two weeks.”

FROM SIMULATION TO REALITY

Dr. Kamal Abulebda, staff physician in critical care for Riley, said despite the low incidence of disease in children, it is crucial that he and his colleagues know what to expect, whether they are treating kids at Riley or supporting adult care teams in other IU Health hospitals.

“We have refined the process in simulation to come up with the best model of care,” he said. “We go through acute-care scenarios, including intubation, cardiac arrest and sedation. We are able to incorporate a lot of lessons we learned in simulated sessions to treat actual patients.”

Specifically, the simulations have taught the 150 PICU nurses, 20 physicians, 10 nurse practitioners and two dozen respiratory therapists how best to work together and communicate while treating a COVID-positive patient and how to use rapid-sequence intubation to decrease the chance of transmitting the virus to healthcare providers.

“We are providing care to acutely ill pediatric patients in very unusual conditions simply because the disease is highly transmittable and we have to find the safest way to provide care,” Dr. Abulebda said.

That means limiting the number of providers in a patient’s room to a core team of physician, nurse and respiratory therapist, reducing exposure to as few people as possible. Outside the room is another team of professionals monitoring the situation, and those teams have to work together to provide the same quality of care to patients. That alone requires new ways of communicating that previously were unnecessary.

“We have to minimize the number of team members involved in caring for patients inside the room, and that clearly has impacted the way the team has to work together,” Dr. Abulebda said.

Calling it a true collaborative model, Dr. Abulebda said it wouldn’t have been possible without interdisciplinary involvement.

Jessalynn Parsley, manager of clinical operations for the PICU, said she believes her nurses on the frontlines caring for patients absolutely feel better prepared.

“When we get the call that we have a potential patient coming in, we have a few moments to go to the sim room and talk through it and prepare them right before their patient comes to the unit,” she said. “It really has helped us to not operate from a place of fear. This is all unknown and we don’t know what is coming, but the mentality is – what can we do now to help us prepare for this the best we can.”

“WE ARE READY TO HELP”

The Riley PICU currently has 36 beds. Ten rooms have been set aside in one area for potential COVID patients. Noting that the PICU has treated two patients for the virus already, Dr. Lutfi is eager to provide support wherever it is needed.

“We want to tell our adult colleagues we’re doing this not just for children. We are getting ready in case they don’t have enough beds and team members, to have our heart open to them to try to care for young adults as well,” he said. “We are here trained to try to take some of the pressure off them.”

Having a dedicated room for simulating patient care is important not just now, but down the road as other challenges hit, Dr. Lutfi said.

“We’ll see how we get through this and see how much damage we will have, but we’ll keep working together.”

Picking up on that sentiment, Dr. Abulebda said Riley’s standing in the state requires it to be a role model for other hospitals.

“We are at the beginning of this crisis, but we are always going to have unexpected disasters or illnesses and we have to be ready because we won’t always have much time to prepare,” he said.

“This is a perfect example. We started preparing when the outbreak was around us, and now it’s hitting us, and we are still working on preparedness, but we have accomplished a lot of our objectives so far. With a lot of effort and time from our amazing stakeholders in this division, we were able to establish this training model for our providers to prepare them to care for actual patients.”

For Dr. Lutfi, this is a lesson learned for the future, and he’s proud that the PICU took it upon itself to push for the training. Already, he said, his team is sharing what they have learned with other children’s hospitals around the nation.

“This room is so valuable. When we got our first patient, we had just finished a good (simulation) run, so people did a brave, fantastic job. Yes, we’re not adult, we don’t have 60 or 100 patients, but we have some and we’re performing pretty well. We are ready to help if the adult side gets swamped,” he said.

“What the team has done here is outstanding – moving from fear of the unknown to being actually ready to take care of these kids.”

Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org

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