Doctors’ Real Stories
R Baby’s programs are saving lives.
Dr. Bryan Jordan
Emergency Department Physician, Bridgeport Hospital, Connecticut
“The R Baby Foundation Simulation Program came to our hospital and offered their program to anyone who wanted to participate. The program was a fantastic simulation and instructional course for the treatment of critically ill children. But, more importantly, is what happened later that day.
I was working in another Emergency Department when an 18-month-old boy, who had been sick for about a day and a half, was brought in by his mother. He had a very fast heart rate and had a fever. He was not responding appropriately. He appeared ill.
The possibilities for serious illness and life threatening conditions required immediate intervention. In addition to my previous training, I utilized the information and procedures reviewed in that day’s R Baby class, specifically the administration of fluids, the constant reassessment of vital signs and the supervision of the Emergency Department Team’s care.
After hydration of the patient by protocol, his rapid heart rate spontaneously resolved. A few short seconds after that his eyes opened, he became more responsive and he smiled when he saw his mother.
In life, things happen for a reason. There was a reason I was there that morning attending the R Baby class. And there was a reason I was in that ED that evening at 7 o’clock. This is why I am sharing this story, because I believe in this simulation training. I think it is a great program. I believe it will make differences in the care of critically ill children.”
4 YEAR OLD INDIANA GIRL WITH SEIZURES RUSHED TO A LOCAL ER
At a community hospital in Indiana, a 4 year old girl arrived in triage, lethargic in her dad’s arms. Her dad reported a recent fever and vomiting, with no history of seizures. The child was found to be actively seizing and was taken to the Pediatric Trauma room. With the knowledge obtained during R Baby funded training, the team knew what steps to take to stabilize, monitor and ultimately make the decision to transfer her.
In 2020, R Baby Foundation provided virtual pediatric training to several community hospitals. This hospital received training on seizure treatment, including the new practice of providing medication through the nose or in the muscle of a child when the providers can not obtain IV access.
According to an imPACTS nurse in the Department of Pediatrics, “We have transferred 10 pediatric seizure patients since last March, and the outcomes would not have been as positive if we had not had the training from PCOME and ImPACTS Telesim. We also hold yearly pediatric competencies in which we review how to care for a pediatric seizure patient. Thank you!”
2 YEAR OLD NEW JERSEY GIRL ARRIVES AT ER UNRESPONSIVE
A previously healthy two year old girl became listless and unresponsive at home after a five day illness with fever and vomiting. On the morning before she arrived at the ER, the vomiting had stopped, and she appeared to be on the mend, looking better than she had in previous days. A little while later however, the toddler began to feel hot, was shivering and vomited. She became unresponsive, pale and turned blue around her mouth. Her mother called 911 and she was transported to the ER. Upon arrival, she appeared very ill, remained drowsy and could barely open her eyes. Her heart was racing, her blood pressure was very low, and her skin was pale and mottled.
Thanks to R Baby’s sponsorship of the training program to improve the outcomes of septic pediatric patients, the ER staff knew to begin immediate treatment. They provided early intravenous fluids for hydration and antibiotics to fight infection. The patient was continually monitored and re-assessed for any changes in her condition. Her heart rate and blood pressure improved, and she became more awake and interactive with her mother and the staff. She was admitted to the Pediatric Intensive Care Unit overnight for monitoring.
The next day she continued to improve and was transferred to the general pediatric inpatient floor. Four days after coming to the hospital, she was discharged home. Had she not been treated early and aggressively the outcome may have been much different. Thanks to the support of the R Baby Foundation, the pediatric staff has been able to incorporate numerous teaching modalities, including simulation, to ensure that pediatric sepsis is recognized and treated in a timely manner. That is what fighting sepsis means.
VIRTUAL TRAINING PAYS OFF FOR CHILD ARRIVING AT ER WITH SEIZURES
R Baby funded doctors provided seizure tele-simulation to a hospital and the next week the hospital had a very similar patient present. The child was successfully treated using the algorithm taught during the simulation session.
A tele-simulation of a sick diabetic patient was performed and when a patient of this type presented to the ER, staff felt much more prepared to take care of her and were more confident in their fluid and insulin management and recognizing the important differences between pediatric and adult patients with a diabetic crisis. Previously they would have used adult protocols and those can be dangerous in children. Participating sites all reported feeling more confident in recognizing abnormal pediatric vital signs and “sick” infants and children. All sites reported more comfort with weight-based dosing for fluids and medication. Survey data from participants shows they uniformly felt more comfortable with pediatric emergencies after participating in the program.
9 YEAR OLD NEW JERSEY GIRL WITH SEPSIS TAKEN TO ER
When it comes to sepsis, early recognition and treatment are critical to preventing harm and dangerous outcomes. A 9 year old girl arrived in the Gagnon Pediatric Emergency Department at Goryeb Children’s Hospital.
She had developed fevers and intermittent vomiting. For about 24 hours prior to her arrival in the ER, she seemed to be doing better and was able to tolerate dinner. She went to bed but was found unresponsive in the morning by her mother. 911 was called and the patient was brought to the ER. On route to the hospital, EMS started an IV and began giving her intravenous fluids. There was some improvement.
When she arrived at the hospital, she was dehydrated and exhibited signs of potential sepsis: fever, fast heart rate and lethargy. Fluids were continued and antibiotics were administered almost immediately. By the time she was moved to a bed in Goryeb’s Pediatric ICU, she was much more alert and able to speak a few words. The child continued to improve and remained in the ICU for only one day and was discharged home a few days later.
This child has Beta Thalassemia, a blood disorder that causes severe anemia for which she requires transfusions; however she lives a healthy life. The fast improvement of this child can be attributed to the clinical team’s prompt recognition that she had sepsis, as well as the intervention and management of treatment for sepsis. Thanks to the support of the R Baby Foundation, Goryeb Children’s Hospital has developed and implemented a dedicated pediatric sepsis program which will continue to help save children’s and babies’ lives.
An R Baby Life-Saving Real Story –An Interview with Dr. Jessica Katznelson, Johns Hopkins Children’s Hospital
There was a recent case of 9-day old baby in one of those hospitals?
A 9-day old baby started showing concerning symptoms. Her parents brought her in and she was not well at all. We had recently done our simulation training at this hospital with the doctors and staff. The doctor in the department was able to quickly make sense of the little girl’s symptoms. He confidently diagnosed an otherwise unrecognized heart defect and was able to deliver the appropriate treatment correctly and quickly.
His knowledge, confidence and agility ultimately saved this little girl’s life. This was because of R Baby’s simulation training.
Read the full interview here.
Pediatric Emergency Department
“A private pediatrician referred a 3-week-old baby whose heart rate was very fast in the office, but when I evaluated the baby in the emergency department the baby was completely well. We did an EKG which was also normal and which recorded a heart rate of 172. Honestly, I thought the baby was fine, but because the PEP vital signs insist on a heart rate of less than 168 for a baby in the ED, I consulted Pediatric Cardiology. They did a bedside echocardiogram that showed decreased function and the baby was diagnosed with ectopic atrial tachycardia, an abnormal heart rhythm that can be life-threatening if undetected, and was admitted to the pediatric ICU.”
Experienced Non-Pediatric Physician
Rural Community ER, Upstate New York
“I cared for an 8-year-old boy who appeared to be very well. If not for that lecture (on PEP Vital Signs for Children) on any other given day I would have contacted the child’s primary care physician and discharged him to follow-up the next day. However, because of your vital signs rules I contacted the pediatric intensivist at SUNY Upstate Medical Center and presented the case to him. He agreed to accept the patient in transfer for observation. I followed up with him in 36 hours and he informed me that the child’s heart did not decrease. Cardiac echo showed a modest but definite depression of cardiac function and there were elevations of cardiac enzymes, and the diagnosis was Myocarditis, a life-threatening inflammation of the heart.”
General Emergency Department
“At an INSPIRE site following training, a report noted two patients with viral meningitis were diagnosed after an intern completed our training and did an effective lumbar puncture. These diagnoses could not have been made if the samples had been filled with blood or not obtained effectively due to failed attempts, and this would have significantly impacted these patients’ lives.”
“There is no better environment in which to train and learn than our own ED, and this is a defining characteristic of this program as code scenarios and advanced simulation technology are brought directly to us. This unique and dynamic education is provided in a thoughtful and purposeful way in a supportive environment where we aren’t afraid to make mistakes.”
“Our staff confidence in code situations has increased by leaps and bounds since the initiation of this program, and it has been extremely gratifying to see our code practice put successfully into action.”
“Staff began this endeavor two years ago with nervous anticipation and anxiety but have now come to embrace the opportunities that the simulations provide. Perhaps the greatest testament to this partnership is how often I am asked with excitement when Dr. Katznelson and her team will be back to work with us again!”
General Emergency Department
A few weeks after our initial ImPACTS sim, we had a 3(ish) year old present to L&M via EMS for seizures. He appeared to be in status seizure on arrival with no IV access. The RN’s that volunteered to be part of ImPACTS happened to be working and all available to be at the bedside.
Typically these situations tend to be “controlled chaos” however, from patient arrival to time of transfer with the transport team, the care provided by the team was overall flawless and smooth. I think we all had that “lightbulb moment” and felt prepared to handle his care because of the education and experience we had through the simulation.
A nurse at one point looked up and said ” Guys, it’s our IMPACTS team working!” I think it really validated not only the importance of simulations but also that simulations do help us in being ready and more comfortable managing these high stress/high acuity pediatric emergencies.
I was able to follow up on the patient a couple days later and he was extubated rather quickly and able to be discharged home after a brief in-patient stay. I look forward to our 2nd Simulation in a couple weeks!
Additional Feedback From Participants
“Thank you for including us in the pediatric Mock Codes. It was such a wealth of information for myself and the staff [in the] ED. I looking forward to working on the list that you have provided to ensure we have evidence based practice and continue to sharpen our skills.”
“They are as close as you can get to the real thing! I always leave the mock codes having learned something and something to practice or be mindful of. Such a good learning experience in a safe environment!”
“Intense, thorough scenarios with great feedback.”
“JHH does a fantastic job with our mock codes. Our previous mock drills don’t even compare.”
“Good learning experience for situations we don’t see often. Helps improve our CPR quality. Helps teach all staff where different supplies are located on unit.”
“Invaluable resource, we are so appreciative of this educational opportunity.”
“Her team continues to push us to improve, constantly supporting our efforts by providing real time and follow-up feedback, and fostering a support system that is a huge part of why this program has been such a success on our unit.”
“At an INSPIRE site following intubation, training, a faculty member noted that they used the checklist right before needing to intubate a patient and credited our checklist with their success in securing a life-support airway in that patient.”