Abstract 307: In-Situ Simulation-Based Booster ACLS Training to Increase the Confidence and Performance of Internal Medicine Residents as Code Blue Leaders - A Quality Improvement Project

Abstract

Background: In the United States, nearly 290,000 adult patients develop in-hospital cardiac arrest (IHCA) every year. Delivery of guideline-based resuscitation has improved patient outcomes. During 2022, our hospital had 68 inpatient i.e., approximately 1 code/resident. Residents have reported desire for more exposure. The 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommended: 1) booster training, 2) in-situ simulation-based resuscitation training, and 3) specific teamwork and leadership training for healthcare providers. We aimed to implement such training to achieve an improvement in resident confidence and performance as code blue leaders. Methods: Pre-intervention, residents completed a 5-item 0-100 continuous scale to assess confidence in major code leader skills (Fig 1-A). Interventions included: 1) Calling residents to patient rooms to run simulation-based codes, and 2) a didactic session that discussed common errors during codes. Time to key ACLS steps was recorded during the simulations. At the end of the project, residents completed the post-intervention survey of confidence and balancing measures. Results: 13 residents led simulation-based codes, 20 attended the didactic session, and 25 completed the survey. Resident confidence in the defined skills increased by an average of 30%. (P<0.05) (Fig 1-A). Residents who led codes after the didactic session had shorter times to key ACLS steps (Fig 1-B). Balancing measures included resident-reported satisfaction and perceived disruption to clinical workflow (100% and 0% of responses, respectively). Conclusions: In-situ simulation-based booster ACLS training was associated with an increase in the confidence and performance of IM residents as code blue leaders. Incorporation of such training in IM residency curriculum should be considered as a practical application to sustain the gains of this QI initiative.