Examining Workflow for Simulated Pediatric Emergency Medical Services Care

Purpose: Workflow analysis is an important approach for understanding clinical care in complex systems. This is particularly true for low frequency events such as the care of children in the out-of-hospital setting. The purpose of this study was to characterize emergency medical service (EMS) workflow in the care of children during simulated emergency, prehospital encounters. Methods: This is a secondary analysis exploring high-fidelity videorecorded simulations, performed by emergency personnel. Two scenarios were used in 19 simulations which consisted of a 15-month and a 1-month old with respiratory decompensation and shock requiring intravenous fluid, respiratory support, and medication administration. One trained investigator performed review of the videos of teams EMS practitioners, quantifying the sequence and number of tasks performed and time to completion of the simulated intervention. The variance in sequence of tasks was quantified using the Levenshtein distance. We quantified the proportion of time with no activity (idle time) and temporal overlap (team multitasking time). Results: We identified 17 types of distinct tasks performed during the simulation. There was high variability across simulations in the sequences, types, and number of tasks performed. Team multitasking was noted in all scenarios, with a mean of 99% multitasking ratio (range: 52-202%). Mean proportion of idle time was 4% (range: 0-11%). Weight estimate, intravenous or intraosseous access, radio report, blood glucose level (BGL), medication administration, pulse check and respiration check were observed in all videos. Other tasks were observed in only a proportion of scenarios with varying frequencies. Median number of differences in sequence of tasks between scenarios was 15. Conclusions: Our analysis found a high percentage of team multitasking and significant variability in frequency and sequence of task completion. Further research is needed to assess the reasons and effect of this degree of variability on the efficiency and effectiveness of prehospital interventions.