Pediatric Critical Care Fellow University of Maryland Children's Hospital Baltimore, Maryland, United States
Background: Simulation medicine is an effective training tool utilized in several pediatric medical education curriculums. Research has demonstrated that the quality of resuscitation performance, cardiac arrest survival rates and timing of tasks are all superior when teams have participated in simulation programs.It is also evident that through these simulation training programs, knowledge gaps surrounding patient safety are identified and mitigated, further reinforcing the need for simulations within hospitals.
Objective: The purpose of this study is to evaluate the impact of including twice-monthly mock codes in our mixed cardiac and pediatric intensive care unit (PICU) as well identifying key barriers to simulation participation. Design/Methods: We conducted twice monthly mock codes in the PICU focus on standards of high-quality cardiopulmonary resuscitation (CPR) metrics followed by a debrief period. Primary outcomes include quantitative data such as effective CPR methods and time taken to administer epinephrine. Secondary objectives looked at qualitative information including barriers to participation and knowledge-based questions through a Likert-scale survey. Results: A total of 15 mock codes were evaluated in phase one. 13% of codes (2/15) had a CPR initiation time less than one minute and 46% of the mock codes (7/15) resulted in the administration of the first dose epinephrine in less than five minutes. During phase two, 12 mock codes were completed, 75% of codes (9/12) met the CPR initiation goal, while 83% (10/12) codes met the epinephrine time goal (Figure 1), demonstrating respectively improvements of 62% (p < 0.002) and 37% (p < 0.107). Barriers identified by participants included not being able to join due to patient assignment, long debrief period and variable participation/expertise due to staff turnover.
Conclusion(s): The significant improvement between phase one and phase two for primary outcomes is apparent. This may be attributed to the repetition of codes and a focused, shorter debrief period aimed at high quality CPR metrics. A novel aspect of this study is identifying the barriers associated with participation. One significant barrier is the consistent turnover of staff within the PICU that contributed to the variable level of expertise within the mock code evaluations thus influencing primary outcomes. Phase three of this project includes addressing the barriers noted by participants and focusing on standardized educational materials that are aimed at high quality CPR metrics.
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