Statewide Quality Improvement Through Paediatric Simulation

Overview

Initiative type

Service Improvement

Status

Deliver

Published

June 2025

Summary

The STORK team used their simulation-based training educational program to mitigate systemic barriers to paediatric resuscitation throughout Queensland.

Dates: 1 March 2023 - 1 December 2023

Implementation sites: Children's Hospital Queensland

Aim

The STORK team collected data on latent safety threats in paediatric resuscitation services around Queensland, developing a reporting system and follow up process that mitigated many issues statewide.

Outcomes

Using simulation to test hospital systems, STORK identified common barriers to paediatric resuscitation.  Their simple reporting system connected change agents in local hospitals with the information found in simulation testing.


Between March and December 2023, 40 Optimus PRIME courses were delivered and 39 course summaries were sent.

From 40 courses delivered across 37 facilities, 242 issues were identified, primarily related to drug safety and equipment management.
At follow-up, 45.5% of the issues were resolved, with 44.6% still being addressed. Recommended resources were successfully implemented in 64% of sites.

Background

Rural Australians have disproportionately lower access to healthcare and poorer health outcomes than those in metropolitan areas (1). Children are specifically vulnerable, because of unfamiliarity with paediatric guidelines, equipment, and decreased resources. (2-6 ). Improving paediatric resuscitation in regional Australia is crucial and dependent on understanding barriers to optimal care.

In Queensland, paediatric resuscitations are infrequent, limiting data collection from clinical events and identification of barriers. This is further complicated by Queensland's size, a state with 106 hospitals distributed over 700m2. While data have been published on regional healthcare in New South Wales (NSW),(5), little is published regarding barriers in rural, remote and regional (RRR) Queensland. Understanding these barriers potentiates targeted efforts to improve paediatric resuscitation in RRR settings.

Simulation provides opportunities to diagnose barriers to optimal care in clinical settings. The Simulation Training Optimising Resuscitation for Kids (STORK) simulation service from Children's Health Queensland, founded in 2014, delivers paediatric education with a mission to ˜'ensure every child in Queensland has access to optimal resuscitative care'. Over the years, our role in statewide education provided unique insights into the realities and resuscitation challenges faced by clinicians in RRR Queensland.

One of the courses that STORK delivers is called 'Optimus PRIME', which focuses on 'Preparing for Retrieval in Medical Emergencies'. In 2023, translational simulation principles were formally integrated into the course. 'Translational simulation' describes 'how simulation may be connected directly with health service priorities and patient outcomes, through interventional and diagnostic functions'. (7). Using simulation to explore the real-world challenges that clinicians face, (8), we sought to understand barriers to optimal paediatric resuscitation in Queensland.

In 2025 we published our findings in Emergency Medicine Australasia, advocating about common challenges facing Queensland clinicians caring for sick children, and advocating for targeted innovation. (9).

Methods

This was a qualitative study using document analysis of course questionnaires, summaries, follow-up forms, and course-related emails generated from 40 Optimus PRIME courses delivered by the STORK team members from March to December 2023 across 37 healthcare facilities in Queensland. Below we provide details about our service (STORK), the course 'Optimus PRIME' and the hospitals included in the present study.

About the STORK Service

STORK is an outreach simulation-based education service involving a multidisciplinary team of simulation educators travelling across Queensland delivering paediatric resuscitation courses. STORK provides training through a spiral curriculum named Optimising Paediatric Training in Emergencies Using Simulation (OPTIMUS). Our curriculum consists of four major constituent courses for first or second tier responders. STORK collaborates with RRR sites interested in the curriculum. During its first decade, STORK delivered 100 x140 courses per year to over 60 hospitals. This work has provided insight into challenges faced by clinicians working in RRR Queensland, and the present study aimed at capturing these.

About Optimus PRIME

STORK's most frequently delivered course, ˜Preparing for Retrieval in Medical Emergencies (Optimus PRIME)', focuses on resuscitation and retrieval of critically unwell children. In this course, faculty support participants to build on current knowledge, understand '˜how to do' and 'what to do' during skills stations and promote knowledge application during simulations - delivered in situ - whenever possible. In our traditional Optimus PRIME course participants listened to specific lectures (e.g.: paediatric airway management), before rehearsing a specific skill (e.g.: preparing intubation as a team) and finally putting it together in a simulation activity (e.g.: severe bronchiolitis requiring intubation).

In our newest version of the course, methodologies from translational simulation were added to the traditional Optimus PRIME course to explore and capture the challenges faced by clinicians across RRR Queensland. Early in the course, the Human Factor framework of 'self, team, environment and system' is introduced, to help participants identify factors shaping their performance during the course. Each issue flagged by participants (e.g. environment problem; no access to computer to help document resuscitation) was documented on a sticky note and displayed on a wall. During course closure, each issue was reviewed, discussed and actionable solutions were co-generated, with local advocates identified for implementation.

Within 14 days after each course, faculty wrote site summaries for stakeholders outlining service strengths and opportunities identified during training, categorised as: issues with (a) drug safety, (b) equipment or departmental layout, (c) resources, and (d) team relationships. Sites were contacted by phone after three months to explore progress and troubleshoot challenges.

Discussion

Simulation-based investigations across Queensland revealed that many issues believed to be local are widespread, and that apparently simple problems often conceal complex, system-level causes. Our findings highlight three critical barriers where statewide coordination could substantially improve paediatric emergency care: infusion pump safety software, access to paediatric resuscitation equipment, and information technology.

1. Infusion Pump Safety Software:

Current infusion pump safety software across Queensland is inconsistent and outdated, creating latent safety risks. Having multiple drug libraries with similar names but differing medications and dosages compromises timely and safe administration. Clinicians frequently override the software, indicating a lack of trust in its reliability. Updates are infrequent and managed by centralised pharmacy units without remote capabilities, leaving regional centres behind. We recommend a statewide strategy to streamline updates, reduce unnecessary profiles, and ensure the software is human-centred and clinically aligned.

2. Access to Paediatric Resuscitation Equipment:

Most sites lack sufficient paediatric resuscitation equipment, echoing findings from the U.S.-based National Paediatric Readiness Project, which linked preparedness with reduced mortality and hospital transfers. Conflicting Queensland Health guidelines lead to cluttered or fragmented storage, with many regional EDs receiving no guidance at all. When equipment is requested, bulk-purchasing costs often prevent procurement. As a result, small hospitals hold mismatched, incomplete supplies. Local workarounds - such as redistributing equipment between services - highlight the need for systemic support. A statewide guideline and central supply model could ensure equitable access without financial waste.

3. Information Technology Access:

Despite open-access paediatric guidelines available via the statewide paediatric emergency care website, many clinicians are unaware of or unable to access them. Barriers include poor internet coverage, lack of Wi-Fi, and limited computer access in resuscitation areas. These findings align with earlier Australian research, which identified awareness, training, and electronic access as key obstacles to guideline use. Our Optimus PRIME course, which embeds use of resources into simulation, significantly improved familiarity with available tools. Separately, the CREDD book - a low-cost, user-friendly cognitive aid for paediatric drug preparation - has proven widely effective. Still, reliable internet remains a major hurdle, especially in RRR (regional, rural, and remote) areas. Without infrastructure improvements, resource availability will remain theoretical, not practical.

4. Conclusion and next steps:

Simulation has revealed actionable opportunities to strengthen paediatric care statewide. Coordinated strategies around infusion pump software, resuscitation equipment standardisation, and IT infrastructure can address systemic gaps. Safe, evidence-based paediatric care requires not just clinical skill but consistent access to the tools and knowledge that support it.  STORK will continue to advocate for solutions at the local and statewide level.

References


1. Australian Institute of Health and Welfare. 'Rural and Remote Health.' Canberra: AIHW,'2024' Available from URL: https://www.aihw.gov.au/¨

2. Pai PK, Klinkner DB. Pediatric trauma in the rural and low resourced communities. Semin. Pediatr. Surg. 2022; 31: 151222.


3. Suruda A, Vernon DD, Reading J et al. Pre-hospital emergency medical services: a population based study of pediatric utilization. Inj. Prev. 1999; 5: 294 - 297.
4. Dharmar M, Marcin JP, Romano PS et al. Quality of care of children in the emergency department: association with hospital setting and physician training. J. Pediatr. 2008; 153: 783 - 789. https://doi.org/10.1016/j.jpeds.2008.05.025

5. Cohn SL, Gautam B, Preddy JS, Connors JR, Kennedy SE. Barriers to the use of paediatric clinical practice guidelines in rural and regional New South Wales Australia. Aust. J. Rural Health 2016; 24: 23 -28.

6. Moore B, Sapien R. The role of the pediatrician in rural emergency medical services for children. Pediatrics 2012; 130: 978 -982.

7. Brazil V., Translational simulation: not 'where' But '˜why?' A functional view of in situ simulation. - Adv. Simul. 2017; 2 - 20.

8. Shorrock S. 'The varieties of human work humanistic systems.' 2016. Available from URL: https://humanisticsystems.com/2016/12/05/the-varieties-of-human-work/

9.St-Onge-St-Hilaire, A., Acworth, J., Lawton, B., Williams, M., Dodson, L. and Symon, B. (2025), Paediatric resuscitation in regional Queensland: A simulation informed biopsy of current system challenges. Emergency Medicine Australasia, 37: e70028. https://doi.org/10.1111/1742-6723.70028

10.Hicks C, Petrosoniak A. 'The human factor: optimizing trauma team performance in dynamic clinical environments.' Emerg. Med. Clin. North Am. 2018; 36: 1-17.

11.Children's Health Queensland Hospital and Health Service. Children's Resuscitation Emergency Drug Dosage (CREDD). Online. Brisbane: Children's Health Queensland Hospital and Health Service, 2024.

Key contact

Dr Ben Symon

Simulation Consultant STORK and Paediatric Emergency Physician

Queensland Children's Hospital

Email: ben.symon@health.qld.gov.au

Last updated: June 2025

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