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Board 103 - Program Innovations Abstract The Code Blue Training Initiative: Phase One (Submission #869)

Introduction/Background Multidisciplinary Code Blue team training is limited at most hospitals. This lack of team training may result in poor communication during actual Code events, which in turn can lead to suboptimal performance. Studies have shown that there is an association between leadership skills and technical skills in simulated cardiac arrest scenarios.1 While improvement in patient outcomes from changes in training can be difficult to demonstrate, process measures can serve as reasonable proxies. For example, a high compression fraction (the fraction of time during a pulseless arrest in which CPR is being performed) has been linked to survival outcomes.2 Over the past year, UC Davis Medical Center has expanded its Code Team training to include in-situ simulation. We aim to improve both the technical and teamwork skills of Code Teams through these events, with the hope that this will eventually translate to improved patient outcomes. Methods High fidelity human patient simulators and standardized scenarios were used to evaluate team performance in the management of simulated cardiopulmonary arrest scenarios. To test feasibility, we first developed cases and process measures then refined the scenarios and data analysis during regular training that took place in a large academic Emergency Department over a six month period. Our team then conducted a series of in-situ "Mock Code Blue" events throughout the hospital in various patient care settings (medical-surgical, telemetry and intensive care units) and at different times of day (morning and night). We collected data using a combination of code process metrics and a validated instrument to assess teamwork. Participants received formative feedback on their performance immediately following the event and again asynchronously via an e-mail debriefing with video attachments demonstrating observed and ideal code team skills. Between August 2012 and June 2013, seventeen simulated cardiopulmonary arrest events were conducted in patient care units throughout the hospital. Performance was recorded and we calculated: CPR fraction, time to epinephrine administration and number of CPR interruptions. We report summary statistics with means and 95% confidence intervals. The mean compression fraction from these scenarios was 68% (95% CI, 61-75%) with a range of 36 to 81%. The mean time to give epinephrine was 357 seconds (6.25 min) (95% CI, 286-428s), with a range of 125 seconds (2.08 min) to 618 seconds (10.30min). The mean number of CPR interruptions in each code was 17 (95% CI, 15-20) with a range of 7 to 24. Conclusion In this sample, the CPR fraction was well below the goal of at least 80% for all of the observed codes. The average time to appropriate pharmacologic therapy was also much longer than the recognized standard of two minutes. While our conclusions are limited by a relatively small sample size, we feel that we have established a reasonable estimation of baseline performance. The next phase of our intervention will involve a combination of online and task based training designed to specifically address code leadership, team communication and technical skill based training. References 1. J. H. Yeung, G. J. Ong, R. P. Davies, F. Gao, and G. D. Perkins, ’Factors Affecting Team Leadership Skills and Their Relationship with Quality of Cardiopulmonary Resuscitation’, Crit Care Med, 40 (2012), 2617-21. 2. J. Christenson, D. Andrusiek, S. Everson-Stewart, P. Kudenchuk, D. Hostler, J. Powell, C. W. Callaway, D. Bishop, C. Vaillancourt, D. Davis, T. P. Aufderheide, A. Idris, J. A. Stouffer, I. Stiell, and R. Berg, ’Chest Compression Fraction Determines Survival in Patients with out-of-Hospital Ventricular Fibrillation’, Circulation, 120 (2009), 1241-7. Disclosures None.