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Abstract

Introduction: The quality of team performance during medical crises impacts patient outcomes. Team performance can be enhanced by simulated or case-based education. Survival after pediatric cardiac arrest is excellent when effective CPR is performed. Measuring team performance during CPR events can identify errors, allowing development of focused team training. Multiple personnel are involved in resuscitative events and hence, multidisciplinary feedback of perceived errors must be sought. Hypothesis: There is a high rate of qualitative errors that occur during CPR events in the PICU and discordance in perception of errors by team members. Methods: A survey was created of demographics and 3 broad categories of errors- 1. Systems issues 2. Improper BLS/PALS application 3. Crisis resource management (CRM) deficiencies. Personnel conducting the surveys were educated about error categories and debriefing techniques. For all cardiopulmonary arrests(CPAs) in the PICU, the Critical Care (CCM) Attending, Fellow, PICU nurse and respiratory therapist that participated in the resuscitation were interviewed, using formatted, yet open-ended questions. Results: There were 30 CPA events from February to July 2012. 6 patients had 2 events each. Spontaneous circulation returned in 24 events (80%). 21 of the 24 patients survived to hospital discharge (84%). The team leader did multidisciplinary code debriefing following 10 events (33%). 360 degree surveys were successfully done for all team members in 28 cases(93%). Only 2 events(6%) were perceived as error-free by all primary respondents. Systems issues were identified by at least 1 team member in 18 events(60%), BLS/PALS deficiencies in 18 events(60%) and CRM deficiencies in 25 events(83%). More than 1 category of error was identified in 23 events(76%). In 14 events(46%), there was lack of clarity about team leadership. Conclusions: There is a significant rate of errors in PICU CPR team performance. Ample opportunity exists to improve the quality of CPR through team training. Based on our results, CRM is the commonest category of qualitative deficiencies during CPAs and must be primarily targeted during multidisciplinary simulation training and mock codes to enhance patient care.