Abstract 10626: Use of Targeted Bedside Simulation in the Pediatric Cardiac Intensive Care Unit: Codes on the Go

Abstract

Introduction: Early recognition of clinical decompensation and rapid intervention are essential to prevention of cardiac arrest (CA). Simulation provides a safe, realistic environment to improve performance of low frequency, high risk skills and practical knowledge. Codes on the Go (COTG) uses mobile bedside simulation emulating the most frequent causes of CA to improve early recognition of clinical changes that may lead to CA and improve performance of crucial tasks. Methods: COTG scenarios are based on our cardiac intensive care unit CA data including trends in etiology and knowledge gaps identified in code debriefs. Each simulation lasts 10 minutes (pre-brief, clinical scenario, and educational debrief). For each simulation, completion and timing of pre-identified objectives were recorded and participant feedback was obtained. Results: We conducted 56 simulations using our pilot scenario “Agitation & Bradycardia”. Of these, 11 involved staff participating for the second time. When comparing the 45 first-time participants to the 11 repeat participants, the tasks showing the largest increase in completion were identifying that dexmedetomidine (dex) can worsen bradycardia, stopping the dex infusion, and using the appropriate CPR ratio. The average time-to-task decreased for 5 of 6 tasks measured between the first-time participants and repeat participants (Figure 1). The vast majority (98%) of participants agreed that feedback was done in a constructive, non-punitive way and the simulation had no negative impact on patient care or staff workflow. Conclusions: COTG is a customizable and low-cost way to improve performance of critical skills and knowledge. Repeat participation in the same scenario improved both completion of objectives and time-to-task without impeding workflow or patient care. This pilot study demonstrated successful proof-of-concept and further implementation of arrest scenario simulations will be implemented to expand its benefit.