Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills

Samuel O Clarke, Ian Julie, Aubrey P Yao, Heejung Bang, Joseph D. Barton, Sameerah M. Alsomali, Matthew V. Kiefer, Ali Hassan Al Khulaif, Muna Aljahany, Sandhya Venugopal, Aaron E Bair

Research output: Contribution to journalArticle

Abstract

Introduction In-hospital cardiac arrest (IHCA) affects 200 000 adults in the USA each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a programme of 'mock codes' improves group-level performance of IHCA skills. Our primary outcome of interest was change in cardiopulmonary resuscitation (CPR) fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesised that a sustained programme of mock codes would translate to greater than 10% improvement in each of these core metrics over the first 3 years of the programme. Methods We conducted mock codes in an urban teaching hospital between August 2012 and October 2015. Mock codes occurred on Telemetry and Medical/Surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital's 'Code Blue' team, and data were recorded by trained observers. Data were summarised using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model. Results Fifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per 6-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly. Conclusions While we observed a significant improvement in CPR fraction over the course of this programme of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.

Original languageEnglish (US)
Pages (from-to)29-33
Number of pages5
JournalBMJ Simulation and Technology Enhanced Learning
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Resuscitation
Heart Arrest
Cardiac
Telemetering
Cardiopulmonary Resuscitation
Telemetry
event
Unit
performance
Defibrillation
Epinephrine
Hospital Rapid Response Team
Teaching
Urban Hospitals
Statistics
descriptive statistics
Teaching Hospitals
Mixed Effects Model
Interval
Repeated Measures

Keywords

  • cardiac arrest
  • in situ
  • mock code
  • simulation
  • team training

ASJC Scopus subject areas

  • Modeling and Simulation
  • Education
  • Health Informatics

Cite this

Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills. / Clarke, Samuel O; Julie, Ian; Yao, Aubrey P; Bang, Heejung; Barton, Joseph D.; Alsomali, Sameerah M.; Kiefer, Matthew V.; Al Khulaif, Ali Hassan; Aljahany, Muna; Venugopal, Sandhya; Bair, Aaron E.

In: BMJ Simulation and Technology Enhanced Learning, Vol. 5, No. 1, 01.01.2019, p. 29-33.

Research output: Contribution to journalArticle

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abstract = "Introduction In-hospital cardiac arrest (IHCA) affects 200 000 adults in the USA each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a programme of 'mock codes' improves group-level performance of IHCA skills. Our primary outcome of interest was change in cardiopulmonary resuscitation (CPR) fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesised that a sustained programme of mock codes would translate to greater than 10{\%} improvement in each of these core metrics over the first 3 years of the programme. Methods We conducted mock codes in an urban teaching hospital between August 2012 and October 2015. Mock codes occurred on Telemetry and Medical/Surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital's 'Code Blue' team, and data were recorded by trained observers. Data were summarised using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model. Results Fifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9{\%} per 6-month time interval on Telemetry units, and 1.3{\%} per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly. Conclusions While we observed a significant improvement in CPR fraction over the course of this programme of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.",
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N2 - Introduction In-hospital cardiac arrest (IHCA) affects 200 000 adults in the USA each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a programme of 'mock codes' improves group-level performance of IHCA skills. Our primary outcome of interest was change in cardiopulmonary resuscitation (CPR) fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesised that a sustained programme of mock codes would translate to greater than 10% improvement in each of these core metrics over the first 3 years of the programme. Methods We conducted mock codes in an urban teaching hospital between August 2012 and October 2015. Mock codes occurred on Telemetry and Medical/Surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital's 'Code Blue' team, and data were recorded by trained observers. Data were summarised using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model. Results Fifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per 6-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly. Conclusions While we observed a significant improvement in CPR fraction over the course of this programme of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.

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