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Best of Scientific Oral Presentations

Simulation Presentations

Session: Best of Scientific Orals 2

PEAK-II Trach: A Multi-Institutional Quality Improvement / Simulation Study Assessing Pediatric Airway Emergency Readiness

Sunday, October 12, 2025
2:54 PM - 3:00 PM EDT
Location: 120
Introduction: Pediatric tracheostomy emergencies are high acuity events that require swift team-based care. In situ simulation is a robust tool to assess team performance and identify latent safety threats (LSTs) in the actual clinical care environment. The PEAK (Prevention of Errors in Acute Conditions in Kids)-II collaborative utilizes simulation and innovative, validated smartphone technology to assess team and system responses to pediatric emergencies across diverse pediatric institutions.

Methods: In situ simulations of pediatric tracheostomy emergencies were conducted as 5-minute scenarios of either tube obstruction or accidental decannulation and were performed by interdisciplinary healthcare teams on pediatric inpatient floors, critical care units, and emergency departments across 10 pediatric hospitals. Scoring of time to critical actions was completed using the NeoCHART+™ PEAK-II mobile application. Systems-level pediatric tracheostomy emergency performance was assessed by synthesizing time-critical actions and LSTs identified through structured post-simulation debriefs. LSTs were categorized by the SEIPS (Systems Engineering Initiative for Patient Safety) 2.0 framework.

Results: From January 2022 to December 2024, 45 baseline simulations were conducted across 10 institutions. 89% of teams completed suction within the 5-minute time limit (median 67, IQR (47, 123) seconds). 62% of teams replaced an identical tracheostomy tube within the time limit (median 164, (135, 206) seconds). LSTs were found in 94% of simulations (median 4, IQR (3, 5) LSTs per simulation). 30% and 34% of LSTs found were categorized into Tasks and Persons/Teams, respectively.

Conclusions: Tracheostomy simulations revealed delays and errors in time-critical actions, as well as common themes in observed LSTs. These findings will inform implementation strategies which integrate human factors, implementation science, followed by reassessment through simulations.

    Presenting Author(s)

  • Olivia E. Dunne, BS

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

    Disclosure information not submitted.

    • Co-Author(s)

  • JB

    Jonathan Biel, BS

    New York Medical College, United States

    Disclosure information not submitted.

  • Amanda Shen, MS

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

    Disclosure information not submitted.

  • RM

    Roxanna Mosavian, BA

    Medical Student
    Albert Einstein College of Medicine
    New York, New York, United States

    Disclosure information not submitted.

  • Marc-Mina N. Tawfik, BS

    Medical Student
    Albert Einstein College of Medicine
    Bronx, NY, United States

    Disclosure information not submitted.

  • Regine M. Fortunov, MD

    Associate Professor of Pediatrics
    Baylor College of Medicine
    Houston, TX, United States

    Disclosure information not submitted.

  • AN

    Akira Nishisaki, MD, MSCE

    Associate Professor, Anesthesiology, Critical Care and Pediatrics
    The Children’s Hospital of Philadelphia
    Philadelphia, PA, United States

    Disclosure information not submitted.

  • TM

    Tensing Maa, MD

    Professor of Clinical Pediatrics
    Nationwide Children’s Hospital
    Columbus, OH, United States

    Disclosure information not submitted.

  • Ilana Harwaye-Gidansky, MD, MA

    Associate Professor
    Albany Medical Center
    Albany, NY, United States

    Disclosure information not submitted.

  • ES

    Elliot Schiff, BA

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

    Disclosure information not submitted.

  • MA

    Monira Albathi, MBBS, MPH

    Nationwide Children's Hospital, United States

    Disclosure information not submitted.

  • ML

    Meredith Merz Lind, MD, FAAP, FACS

    Professor
    Nationwide Children's Hospital/ The Ohio State University
    Columbus, OH, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Pooja A`` Nawathe, MD, FAAP, FCCM, FSSH, CHSE-A, CHSOS

    Professor of Pediatrics, Cardiology, Biomedical Sciences
    Cedars-Sinai Medical Center
    Los Angeles, CA, United States

    Disclosure information not submitted.

  • DC

    Daniel Chiou, MD

    Cedars-Sinai Medical Center, United States

    Disclosure information not submitted.

  • AG

    Ankona Ghosh, MD

    Clinical Instructor
    Cedars Saini Hospital
    Los Angeles , CA, United States

    Disclosure information not submitted.

  • AW

    Alanna M. Windsor, MD

    Assistant Professor
    Montefiore Medical Center
    Bronx, NY, United States

    Disclosure information not submitted.

  • AV

    Adam J. Van Horn, MD

    Dr. Adam Van Horn
    University of Michigan
    Ann Arbor, MI, United States

    Disclosure information not submitted.

  • KA

    Kamal Abulebda, MD

    Associate Professor of Clinical Pediatrics
    Riley Hospital for Children at Indiana University Health
    Indianapolis, IN, United States

    Disclosure information not submitted.

  • KV

    Kristin Van Genderen, MD

    Lurie Children's Hospital of Chicago, United States

    Disclosure information not submitted.

  • LK

    Lindsay R. Koressel, MD, MEd

    Assistant Professor
    Lurie Children's Hospital of Chicago
    Chicago, IL, United States

    Disclosure information not submitted.

  • AZ

    Adrian Zurca, MD, MEd

    Lurie Children's Hospital of Chicago, United States

    Disclosure information not submitted.

  • TC

    Todd Chang, MD, MAcM

    Childrens Hospital Los Angeles, United States

    Disclosure information not submitted.

  • James W. Beal, DO

    Assistant Professor, Pediatric Critical Care Attending
    Penn State Health Milton S. Hershey Medical Center
    Lititz, PA, United States

    Disclosure information not submitted.

  • PI

    PedsTrachReady Investigators, Other

    Montefiore Medical Center, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • CY

    Christina J. Yang, MD, MS

    Associate Professor
    Montefiore Medical Center
    Bronx, NY, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.