Practice Makes Better: Making the Case for a Novel Hospitalist Resuscitation Curriculum.

Abstract

The prevalence of cardiopulmonary arrest in pediatric inpatients is roughly 1 in every 1300 admissions.1 These code situations can be both clinically challenging and anxiety producing for the anticipated code team leaders. Hospitalists practicing at tertiary children’s hospitals have the luxury of a robust, highly trained, and experienced PICU team that takes over the resuscitative efforts, usually within 5 minutes of the code call. That is not necessarily the case in many community hospitals where pediatric hospitalists practice. Most often they are expected to lead resuscitative efforts through to resolution, including a postresuscitative phase while awaiting critical care transport. Delays in transport or rapid decompensation may leave pediatric hospitalists vulnerable to self-doubt and burnout if they are not confident in their resuscitation efforts.2 Despite an almost universal mandate for cardiopulmonary resuscitation (CPR) training (Basic Life Support and Pediatric Advanced Life Support [PALS]) every 2 years, the rarity of participation in actual arrest events or other opportunities to refresh these skills leads to significant skill decrements over time. In a study with military pediatric residents, researchers demonstrated this point. When residents were trained to “mastery” levels, 92% maintained their mastery at 2 months, but only 56% retained mastery by 6 months.3 Hospitalists are expected to perform better than pediatric residents, yet their routine exposure to refresher training is usually much less frequent. Additionally, there is a significant discrepancy between resuscitation knowledge and skill retention.4 Proficiency in cognitive matters does not necessarily indicate proficiency in the practical life-saving, hands-on skills.5 Fortunately, many pediatric inpatient …