Abstract 310: Impact of "Cognitive Aids" on Responder Performance During Pediatric Code Blue Simulations - Results From Performance Improvement Project at a Tertiary Care Center in Saudi Arabia

Abstract

Introduction: Despite advances such as high-fidelity code blue simulations, pediatric In-Hospital Cardiac Arrest mortality rate has plateaued at 62% in the USA. It is expected to be higher in low-income countries. Studies show deviations from the PALS guidelines despite regular PALS training due to skills and knowledge decay. Use of simple, easily accessible resources as “Cognitive Aids”, that decrease reliance on memory during stressful events, however, has not been studied well. Aim: To evaluate impact of cognitive aids on resuscitative capabilities of code-blue responders during simulations. Method: Performance Improvement (PI) project by Pediatrics Department at King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia. Simulations were run by Consultant, Pediatric Intensivist and PICU nurse on regular pediatric floors. A performance assessment checklist and a scoring tool were designed to evaluate team members for responsiveness, effective resuscitation, effective communication and resource utilization. Results: A total of 94 responders participated multiple times in 35 simulations that were conducted in two phases: Codes 1 - 19 as the Pre-PI phase and Codes 20 - 35 as Post-PI phase. Cognitive aids were not utilized during the Pre-PI codes and based on the assessment scores, interventions were introduced in the form of A3 size PALS resuscitation cards, “Pediatric Cardiac Arrest Resuscitation Direction” document with prompts to facilitate smooth running of the code and SBAR notes. Based on the scores, improvement was observed in responsiveness by 27% (Pre-PI:192/262 vs. Post-PI:222/223), effective resuscitation by 38% (Pre-PI:293/511 vs. Post-PI:409/431), effective communication by 46% (Pre-PI:94/245 vs. Post-PI:173/207) and resource utilization by 56% (PrePI:37/94 vs. Post-PI:76/80). Total of 36 (38%) responders participated in actual pediatric cardiac arrests after project completion and 97% (35/36) reported higher confidence. Conclusion: Cognitive aids were helpful supportive tools in overcoming skills and knowledge decay and enhance team performance and quality of resuscitation during code blue simulations. We suggest use of such tools wherever high-fidelity simulation training may not be available.