Mock Code Research Articles

P153: Preparedness of Canadian physician offices for paediatric emergencies

Introduction: Background: Studies in the US have demonstrated that many primary care staff and offices are inadequately prepared for paediatric emergencies. Although the Canadian Paediatric Society (CPS) recently reaffirmed their Guidelines for Paediatric Emergency Equipment and Supplies for a Physicians Office, no evaluation has been made regarding the impact of publishing these recommendations, or on the state of preparedness for paediatric emergencies in family physician offices. Objectives: The aim of this study was to evaluate awareness and adherence of family physicians in Ontario to the CPS guidelines on preparedness for paediatric emergencies. Methods: We conducted a province-wide, cross-sectional survey of 749 randomly selected family physicians. Participants were asked to complete a 14-question survey regarding clinic characteristics, incidence of paediatric emergencies, and preparedness of the clinic in the case of a paediatric emergency. Ethics approval was obtained from the regional Ethics Review Board. Results: 104 physicians responded to our Ontario survey (response rate of 14.8%). 71.2% of respondents reported seeing more than 10 children per week, and 58.7% and had experienced at least one paediatric emergency in the past year. The proportion of physicians reporting paediatric emergencies within the last year increased with the number of children seen - 37.9% of physicians who saw fewer than 10 children per week reported an emergency, compared to 85.7% of those who saw more than 40 children per week. 85.6% of respondents reported that they were unaware of the CPS guidelines on paediatric emergency preparedness. Only 9.6% of respondents were aware of the guidelines, and even fewer, 3.8% had read them. Of the physicians who were unaware of the guidelines, 4.5% [CI=0.2, -0.09] engaged in mock code sessions, 29.2% [CI=0.2, 0.2] were up-to-date on Paediatric Advanced Life Support (PALS), 1.1% [CI=0.03, -0.01] had written protocols outlining safe transport of children to hospitals, and 50.6% [CI=0.4, 0.6] stocked half or more of the recommended supplies. In comparison, of the physicians who were aware of the guidelines, 14.3% [CI=0.3, -0.04] engaged in mock code sessions, 35.7% [CI=0.1, 0.6] were up-to-date on PALS, 7.1% [CI=0.2, -0.06] had written protocols, and 78.6% [CI=0.8, 0.8] stocked half or more of the recommended supplies. Conclusion: A large proportion of respondents had experienced at least one paediatric emergency in the past year, but were overall underprepared. The majority of respondents, 85.6%, were not aware of the guidelines, compared to 9.6% who were aware of them. However, offices with the latter were more adherent to the guidelines recommendations. It will be important for CPS to consider how to further advocate for paediatric emergency preparedness in clinics that see children regularly.

Assessing the Usefulness of a Mock Code Curriculum

BACKGROUND: Although health care providers are trained for pediatric cardiopulmonary resuscitation (CPR) using Pediatric Advanced Life Support (PALS) courses, there is a gap between training and performance. Pediatrics residents do not feel adequately prepared for these events outside of PALS, and multiple studies show that the skills developed during PALS progressively decline reaching pretest levels in 1-2 years. Studies done in Children’s hospitals show that this gap can be bridged by periodic mannequin simulation sessions. They also report an overall increase in readiness to codes …

Assessing the Usefulness of a Mock Code Curriculum

Assessing the Usefulness of a Mock Code Curriculum

Jigsaw Method for Non-technical Skills in Cardiac Arrest: a Novel Application of This Active Learning Pedagogy

There has been increased recognition of the importance of non-technical skills (e.g., communication and leadership) for cardiac arrest management. However, training is often insufficient to cultivate the requisite level of proficiency of these non-technical skills. We evaluated non-technical and technical skills performance of internal medicine residents in simulated cardiac arrest cases prior to and following a novel application of an interactive teaching strategy known as the Jigsaw Method. This method is one of the several established teaching strategies intended to actively engage learners. Internal medicine residents participated in pre- and post-intervention medical knowledge quizzes and cardiac arrest simulation cases. Technical skills (i.e., medical knowledge) were assessed by multiple-choice quizzes and non-technical skills (i.e., leadership, communication) with performance scoring. Fifty-six residents, including 50 of 53 (94%) matriculated senior residents from within the internal medicine program, participated. There was statistically significant improvement in quiz scores (median 63.3 vs. 80.0, p < .0001) and mock code performance scores (median 58.4 vs. 72.1, p = 0.01), comprising both leadership and communication components. Application of the Jigsaw Method resulted in improved technical and non-technical cardiac arrest management skills. Our findings support the implementation of this active teaching-learning technique into graduate medical education (GME) for non-technical skills training.

Impact of Mock Code Stroke on Door to Needle times (P4.247)

Impact of Mock Code Stroke on Door to Needle times (P4.247)

Using simulation with interprofessional team training to improve RRT/code performance

Abstract Early recognition of and response to changes in patients' conditions are a National Patient Safety Goal. Rapid Response Teams (RRTs) are one safety strategy aimed at early recognition of signs and symptoms of clinical deterioration and reduction in rates of cardiopulmonary arrest and death in hospitalized patients. Mock codes and RRTs are another strategy for improving outcomes.The Corporal Michael J. Crescenz VA Medical Center(CMCVAMC) used data from the American Heart Association National Registry of Cardio-Pulmonary Resuscitation to create an interprofessional, collaborative program using simulation. The program included: review of emergency responses and hands-on sessions with crash cart equipment, airway management, and BLS skills, followed by a mock RRT and Code with debriefing. Participants in this quality improvement initiative were nurses, physicians, anesthetists, pharmacists, and respiratory therapists. They evaluated the simulation as a positive learning experience. Staff and patient outcomes were improved after the program. The program engaged staff and promoted interprofessional collaboration that may ultimately improve the quality of patient care.

Primary Care Office Preparedness for Pediatric Emergencies.

Emergencies do occur in pediatric primary care offices. The American Academy of Pediatrics Committee on Pediatric Emergency Medicine recommends that primary care offices perform a self-assessment of office readiness for emergencies. Primary care offices should develop an emergency response plan to recognize, stabilize, and transfer sick children. They should also ensure their offices have the essential equipment, supplies, and medications readily available in case of emergencies. Primary care offices can prepare and practice for office emergencies through "mock codes" and by maintaining certification in basic and advanced life support courses. Partnership with local emergency medical services and emergency departments will allow seamless transfer of an acutely ill child. Careful planning and preparation will help improve outcomes for emergencies in the primary care setting. [Pediatr Ann. 2018;47(3):e93-e96.].

Mock code training to enhance CPR skills

Chu, Ruby PhD, RN, CCRN; Robilotto, Tracey DNP(c), MSN Ed, APRN, ACNS-BC Author Information

Cognitive Aids Do Not Prompt Initiation of Cardiopulmonary Resuscitation in Simulated Pediatric Cardiopulmonary Arrests.

Although American Heart Association guidelines exist for proper management of cardiopulmonary arrest (CPA), in-hospital cardiopulmonary resuscitation (CPR) may be of poor quality and is not performed in all indicated situations. Cognitive aids have been created to assist in rapid, accurate recall of guidelines for pediatric CPA management. Pediatric residents participated in individual mock codes for two years. Using a high-fidelity simulator, each resident participated in a standardized scenario that required management of both pulseless ventricular tachycardia and pulseless electrical activity. The primary study objective was to calculate the proportion of residents (a) who were not performing CPR on a simulated "pulseless" patient when cognitive aid use was first initiated and (b) who subsequently initiated CPR after cognitive aid use. One hundred thirty-two (83.5%) of 158 pediatric residents participated, and of 125 videos available for review, 107 residents (85.6%) used a cognitive aid. Mean (SD) time to cognitive aid use was 106 (100) seconds after the mannequin became pulseless. Most common immediate actions prompted by cognitive aid use were the following: defibrillation, 43 (40%) of 107; and adrenaline (epinephrine) administration, 28 (26%) of 107. Most alarmingly, 58 (54%) of 107 were not performing CPR on the pulseless patient when cognitive aid use was initiated and only two (3.4%) of 58 were subsequently prompted to initiate chest compressions. Cognitive aids in use during this study did not prompt timely initiation of CPR, potentially contributing to delays and errors in CPA management. Failure of these aids to prompt CPR initiation represents a "missed opportunity" to enhance performance of this vital skill.

Epidemiology of the Critically Ill Child in the Resuscitation Bay.

Children account for approximately 33 million annual emergency department (ED) visits in the United States. The spectrum and frequency of children with a critical illness presenting to an ED has not been previously analyzed. The purpose of this study was to examine the range of critical illness presenting to a tertiary Children's Hospital ED. This study was a retrospective chart review of all pediatric patients requiring immediate care in the medical resuscitation bay during a 25-month period from August 2005 to September 2007. Data are from a single center, academic, tertiary care pediatric hospital. A log of all patients requiring immediate care is kept in the medical resuscitation bay. Patients recorded in the log for a period of 25 consecutive months were reviewed for type of critical illness, frequency of critical illness, mode of arrival, and outcome. Trauma patients were excluded. There were approximately 45,000 pediatric visits per year with a total of 87,766 patients seen during the study period. There were 249 pediatric patients who required care in the medical resuscitation bay during the reviewed period. Complete data were obtained from 242 subjects' charts. Patients requiring immediate care accounted for 0.28% of all the visits. This study documents the infrequent need for pediatric critical care in the ED of a nonacademic tertiary children's hospital in the United States and reinforces the need to provide protocols, mock codes, and simulation labs in preparation for critically ill children.

Chance Favors the Prepared Mind- a Quality Improvement Initiative Through a Mock Code Based Educational Curriculum for Pediatric Residents in a Community Hospital

Chance Favors the Prepared Mind- a Quality Improvement Initiative Through a Mock Code Based Educational Curriculum for Pediatric Residents in a Community Hospital

The Call and the Challenge of Pediatric Resuscitation and Simulation Research in Low-Resource Settings.

The greatest burden of younger than 5 years mortality is in low- and middle-income nations where education resources are often few. The World Health Organization recommends scale-up of simulation in these settings, but it has been poorly studied. Although there has been an increase of contextualized resuscitation simulation programs designed for these settings, sustaining clinical outcomes and provider skill retention have remained research gaps. Our team designed a study to evaluate skill retention after an initial Helping Babies Breathe training at a rural Kenya referral hospital between randomized learner groups receiving supervised mock codes with debriefing versus just-in-time training with a peer. Although we saw sustained skills retention and some clinical improvements, we were unable to answer our research question because of numerous challenges, mainly that hospital leadership preferred the implementation of 1 arm of the study over another because of lack of protected education time and resources, eliminating differences between randomized study groups. Further challenges included lack of familiarity with simulation and debriefing and lack of protected educational resources and time, cultural differences in giving feedback, undeveloped systems for documentation, and high acuity and clinical volume. Our experience teaches many important lessons in how best to implement and study simulation in low-resource settings. Best practices include long-term partnerships, flexibility, community and staff engagement, mixed methodologies including community-based participatory methods, and careful attention to educational and research capacity building.

Impact of Simulation-Based Team Leader Training on Resident Performance in Mock Codes

Impact of Simulation-Based Team Leader Training on Resident Performance in Mock Codes

Does Simulation Training for Critical Care Nurse Practioners Improve Comfort Levels in a Code Blue?

SESSION TITLE: Medical Education SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: The role of critical care nurse practitioners is increasing in Intensive Care Units (ICUs). They may be the first code captain to respond. Simulation training was performed, and its affect on comfort levels was assessed. METHODS: Critical care nurse practitioners (18) who respond to code blues at Baylor University Medical Center in Dallas, underwent simulation training using a 3G Sim Man in a simulation lab. Pre-training comfort levels were assessed via anonymous survey, followed by a mock code after which feedback was provided. A lecture and tools were given to facilitate actions during a code. Participants then repeated a mock code and anonymous assessments. RESULTS: A total of 83% had prior simulation training. When first asked about comfort level in participating in a code, 22% were slightly comfortable, 33.5% were moderately comfortable, 33.5% were very comfortable, and 11% were extremely comfortable. When asked to rate their comfort level as a code captain, 28% were not at all comfortable, 22% were slightly comfortable, 33% were moderately comfortable, 11% were very comfortable, and 6% were extremely comfortable. When asked about anxiety levels at having to be a code captain, 28% indicated their anxiety level was minimal, 44% as moderate, 17% as high, and 11% as very high. Post training, 78% of participants indicated the simulation experience changed their perceived comfort level in participating in a code. 61% reported that the simulation experience improved their anxiety levels, while 6% indicated the simulation experience increased their anxiety levels and 33% indicated their anxiety levels remained the same. When asked about comfort level in participating in a code as a code captain, 6% were not at all comfortable, 22% were slightly comfortable, 39% was moderately comfortable, 27% were very comfortable, and 6% were extremely comfortable. Simulation training was found to be valuable by 100% of respondents. CONCLUSIONS: Survey assessment showed improved comfort and reduced anxiety levels for nurse practitioners participating as code captains. Simulation was found to be valuable by all participants and many wanted continued drills. CLINICAL IMPLICATIONS: Code blue simulation training is a valuable tool for reducing anxiety levels and increasing comfort levels for nurse practitioners as they play an increasingly important role in many ICU settings. DISCLOSURE: The following authors have nothing to disclose: John Watson, Courtney Coker, Maren Wiseheart, Lizzy Wooley, Ginger Tsai-Nguyen, Adam Mora No Product/Research Disclosure Information

311 Are Pediatric Senior Residents Ready to Perform as Team Leaders During Pediatric Codes?

With scarcity of exposure to real codes during pediatric residency training, mock codes provide an opportunity to increase trainee’s confidence, knowledge, and comfort in managing pediatric emergencies. We hypothesized that pediatric senior residents perform better as team leaders if they are exposed to weekly mock codes compared to monthly mock codes during their training. Prior to implementation of weekly mock codes, our residents were exposed to them monthly. They were tested as code leaders at baseline (control group) before implementation of weekly mock codes and again one year after implementation. Leadership skills were assessed by using Team Emergency Assessment tool (TEAM). TEAM rates 11 behavioral aspects of the whole team on a Likert scale of 0-4. Paired t-test was used to compare mean TEAM scores between the groups. SAS 9.4 (SAS Institute Inc. Cary NC) was used for the analysis. P<0.05 was considered statistically significant. Senior residents’ leadership skills improved after exposure to weekly mock codes on average by 9.5 points (71.93 vs 81.4 respectively, p =0.01). Teamwork and task management skills also improved although not statistically significant. Senior residents should be exposed to frequent simulation sessions in order to achieve milestones in emergency preparedness and skills as leaders in case of real life code.

Using High-Fidelity Simulation and Video-Assisted Debriefing to Enhance Obstetrical Hemorrhage Mock Code Training.

The purpose of this descriptive, one-group posttest study was to explore the nursing staff's perception of the benefits of using high-fidelity simulation during mandated obstetrical hemorrhage mock code training. In addition, the use of video-assisted debriefing was used to enhance the nursing staff's evaluation of their communication and teamwork processes during a simulated obstetrical crisis. The convenience sample of 84 members of the nursing staff consented to completing data collection forms and being videotaped during the simulation. Quantitative results for the postsimulation survey showed that 93% of participants agreed or totally agreed that the use of SimMan made the simulation more realistic and enhanced learning and that debriefing and the use of videotaped playback improved their evaluation of team communication. Participants derived greatest benefit from reviewing their performance on videotape and discussing it during postsimulation debriefing. Simulation with video-assisted debriefing offers hospital educators the ability to evaluate team processes and offer support to improve teamwork with the ultimate goal of improving patient outcomes during obstetrical hemorrhage.

SimZones: An Organizational Innovation for Simulation Programs and Centers.

The complexity and volume of simulation-based learning programs have increased dramatically over the last decade, presenting several major challenges for those who lead and manage simulation programs and centers. The authors present five major issues affecting the organization of simulation programs: (1) supporting both single- and double-loop learning experiences; (2) managing the training of simulation teaching faculty; (3) optimizing the participant mix, including individuals, professional groups, teams, and other role-players, to ensure learning; (4) balancing in situ, node-based, and center-based simulation delivery; and (5) organizing simulation research and measuring value. They then introduce the SimZones innovation, a system of organization for simulation-based learning, and explain how it can alleviate the problems associated with these five issues.Simulations are divided into four zones (Zones 0-3). Zone 0 simulations include autofeedback exercises typically practiced by solitary learners, often using virtual simulation technology. Zone 1 simulations include hands-on instruction of foundational clinical skills. Zone 2 simulations include acute situational instruction, such as clinical mock codes. Zone 3 simulations involve authentic, native teams of participants and facilitate team and system development.The authors also discuss the translation of debriefing methods from Zone 3 simulations to real patient care settings (Zone 4), and they illustrate how the SimZones approach can enable the development of longitudinal learning systems in both teaching and nonteaching hospitals. The SimZones approach was initially developed in the context of the Boston Children's Hospital Simulator Program, which the authors use to illustrate this innovation in action.

Distributed Learning: Revitalizing Anesthesiology Training in Resource-Limited Ethiopia.

Ethiopia has a significant paucity of available health-care workers. Despite the increasing number of medical schools, there are not enough physician instructors. Furthermore, availability and standardization of postgraduate training are lacking. Modalities of e-learning have been shown to be successful when used to impart medical education in other resource-limited countries. The Emory University and Addis Ababa University (AAU) Departments of Anesthesiology have formed a collaboration with the intent of improving the AAU Anesthesiology residency program, one of two postgraduate training programs for anesthesiology in Ethiopia. An initial educational needs assessment identified areas in the existing training program that required improvement. In this pilot study, we describe how the current classroom-based curriculum is augmented by the introduction of interactive educational sessions and distributed learning in the form of video lectures. Video lectures covered topics based on areas identified by Ethiopian residents and faculty. Interactive sessions included hands-on ultrasound workshops and epidural placement practicums, a journal club, problem-based learning sessions, and a mock code simulation. Assessment of the additions of the newly introduced blended learning technique was conducted via pre- and posttests on the topics presented. Pre- to posttest score averages increased from 54.5% to 83.6%. An expansion of educational resources and modes of didactics are needed to fill the gaps that exist in Ethiopian anesthesiology training. Incorporating distributed learning into the existing didactic structure may lead to more efficacious instruction resulting in a higher retention rate of information.

A Framework for Determining the Return on Investment of Simulation-Based Training in Health Care.

This article describes a framework that has been developed to monetize the real value of simulation-based training in health care. A significant consideration has been given to the incorporation of the intangible and qualitative benefits, not only the tangible and quantitative benefits of simulation-based training in health care. The framework builds from three works: the value measurement methodology (VMM) used by several departments of the US Government, a methodology documented in several books by Dr Jack Phillips to monetize various training approaches, and a traditional return on investment methodology put forth by Frost and Sullivan, and Immersion Medical. All 3 source materials were adapted to create an integrated methodology that can be readily implemented. This article presents details on each of these methods and how they can be integrated and presents a framework that integrates the previous methods. In addition to that, it describes the concept and the application of the developed framework. As a test of the applicability of the framework, a real case study has been used to demonstrate the application of the framework. This case study provides real data related to the correlation between the pediatric patient cardiopulmonary arrest (CPA) survival rates and a simulation-based mock codes at the University of Michigan tertiary care academic medical center. It is important to point out that the proposed framework offers the capability to consider a wide range of benefits and values, but on the other hand, there are several limitations that has been discussed and need to be taken in consideration.

Mock Code: A Code Blue Scenario Requested by and Developed for Registered Nurses.

The use of simulation in medical training is quickly becoming more common, with applications in emergency, surgical, and nursing education. Recently, registered nurses working in surgical inpatient units requested a mock code simulation to practice skills, improve knowledge, and build self-confidence in a safe and controlled environment. A simulation scenario using a high-fidelity mannequin was developed and will be discussed herein.