163

Abstract

Introduction: Through enhanced situational awareness and mitigation plans, the frequency of Code Events in our institution has decreased dramatically in recent years. The code team thus has less experience in actual codes and depends more upon simulation to assure maintenance of a high-performing team. In situ simulation with randomly called mock-codes is a mainstay of training and testing the system’s ability to respond. Process goals during code events including use of mental modeling, effective positioning of code team members/equipment, and clear communication of patient information are vital components of an effectively run medical code. Using in situ simulation and deliberate practice incorporating these features over the last 6 months, we have demonstrated a significant improvement in simulated code performance. Despite these advances, we hypothesize that there remains even more room for team improvement and efficiency. The modification of standard simulation based training techniques may thus further improve code team performance. Methods: Randomly called mock code events were performed at our institution in varying locations. Following the arrival of all code team members and allowing them time to assume their pre-assigned roles, a pause was performed. During this, observation of each code team member’s location and the location of vital equipment (defibrillator, ‘crash’ cart) was recorded. If sub-optimally positioned, the members and/or equipment were repositioned and the code event resumed. Other variables recorded during the pause included the number of staff in the room without defined roles, the number of staff performing roles outside of their defined scope, and the presence/absence of a medication pause or team leader mental model. Following completion of the mock code, coaching specific to each component was performed by the simulation team, and a survey was handed out to assess self-perceived value of the pause intervention. Results: During each simulation, >1 code member was found to be improperly positioned for their assigned role during the pause. Several participants were found in the room without clearly defined roles including an additional 13 participants during one event. Of those participants without defined roles, a tendency existed for them to perform roles clearly designated to code team members and potentially outside of their scope. 89% of code team members felt more confident in obtaining their proper position during code events based upon the post-code questionnaire. Conclusions: Utilization of a ‘mid-code event pause’ during medical simulation allows for a real-time recognition of suboptimal conditions during simulated code events and has great potential for improving basic process goals. Further research is needed to assess the impact of this intervention upon such relevant patient outcomes as efficacy of CPR, time to defibrillation, and time to establishment of IV/IO access.