Nancy Sullivan

Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial

BACKGROUND Traditional American Heart Association (AHA) cardiopulmonary resuscitation (CPR) curriculum focuses on teams of two performing quality chest compressions with rescuers on their knees but does not include training specific to In-Hospital Cardiac Arrests (IHCA), i.e. patient in hospital bed with large resuscitation teams and sophisticated technology available. DESIGN A randomized controlled trial was conducted with the primary goal of evaluating the effectiveness and ideal frequency of in-situ training on time elapsed from call for help to; (1) initiation of chest compressions and (2) successful defibrillation in IHCA. METHODS Non-intensive care unit nurses were randomized into four groups: standard AHA training (C) and three groups that participated in 15 min in-situ IHCA training sessions every two (2M), three (3M) or six months (6M). Curriculum included specific choreography for teams to achieve immediate chest compressions, high chest compression fractions and rapid defibrillation while incorporating use of a backboard, stepstool. RESULTS More frequent training was associated with decreased median (IQR) seconds to: starting compressions: [C: 33(25-40) vs. 6M: 21(15-26) vs. 3M: 14(10-20) vs. 2M: 13(9-20); p < 0.001]; and defibrillation: [C: 157(140-254) vs. 6M: 138(107-158) vs. 3M: 115(101-119) vs. 2M: 109(98-129); p < 0.001]. A composite outcome of key priorities, compressions within 20s, defibrillation within 180 s and use of a backboard, revealed improvement with more frequent training sessions: [C:5%(1/18) vs. 6M: 23%(4/17) vs. 3M: 56%(9/16) vs. 2M: 73%(11/15); p < 0.001]. CONCLUSION Results revealed short in-situ training sessions conducted every 3 months are effective in improving timely initiation of chest compressions and defibrillation in IHCA.

Improving Posthospital Discharge Telephone Reach Rates Through Prehospital Discharge Face-to-Face Meetings

Purpose of the Study: The purpose of this study was to determine whether a face-to-face meeting with patients by a telephonic case manager prehospital discharge would result in increased telephone follow-up (TFU) reach rates posthospital discharge. Primary Practice Setting: Acute care adult medicine inpatient units. Methodology and Sample: A quasiexperimental design was utilized. Two adult inpatient medicine units were selected as the intervention and comparison groups. The framework of the study is the transitions theory. A convenience sampling technique was used, whereby 88 eligible patients on the intervention unit received face-to-face meetings prehospital discharge whereas 123 patients on the comparison unit received standard care (no face-to-face meetings). Cross-tabulation and chi-square tests were employed to examine the association of face-to-face meeting intervention and TFU reach rates. Results: Implementing brief (<10 min) face-to-face meetings by a telephonic case manager prehospital discharge resulted in a TFU reach rate of 87% on the intervention unit, whereas the comparison unit only had a 58% TFU reach rate (p < .001). Implications for Case Management Practice: Increasing reach rates by a telephonic case manager facilitates communication with more patients posthospital discharge. A brief prehospital discharge face-to-face meeting with patients assisted them to understand the reasons for a posthospital discharge telephone call, identified the best times to call using accurate telephone numbers, and taught patients how best to prepare for the call. In addition, by meeting patients face-to-face, the telephonic case manager was no longer an unknown person on the telephone asking them questions about their medical condition. These factors combined may have significantly helped to increase TFU reach rates.

Board 507 - Technology Innovations Abstract A Device To Allow Anterior-Posterior (AP) Defibrillation in Simulators Lacking AP Electrode Contact Points. (Submission #1162)

Introduction/Background Simulation-based training can be an effective method of improving quality of CPR. Pediatric providers with hands-on experience with a defibrillator are 87% more likely to successfully defibrillate in a given period of time.1 Evidence increasingly suggests that training using high-technology simulators (HTS) Results in significant performance advantages for learners in comparison with low-technology simulators (LTS).2-5 HTS currently used to teach BLS and PALS only allow for defibrillation with pads or paddles in the anterior-lateral (AL) position; the majority of simulators used for BLS training offer no defibrillation capability. Providers caring for pediatric patients frequently place pads in the anterior-posterior (AP) position. This reflects defibrillator manufacturer recommendation, which often influences hospital protocol. There are currently no HTS that allow for realistic training of AP defibrillation in children. Additionally, training programs in lower resourced areas often do not have access to HTS. The device described here extends the functionality of HTS with AL functionality and LTS unable to be defibrillated. Methods This device is a non-conductive belt that encircles the simulator chest. The device redirects simulated cardiac rhythm signals and defibrillator electricity via conductive studs in the AP position. When used with HTS, the device allows for cardiac rhythm signal flow from the simulator’s existing AL contact points (which become concealed) to the AP device studs. When used with LTS, the signal flow between an external rhythm simulator and the defibrillator travels through the conductive studs in the AP position via attachment of the electrode pads to the studs and attachment of the device to the rhythm simulator. Tests for safety and signal modification have been conducted. The device can safely conduct defibrillation shock and cardiac rhythm simulator electrical signals. Electricity up to 200J with an impedance of approximately 70&OHgr; was successfully delivered to the device; this is comparable to conductive/resistive characteristics of current HTS. Results: Conclusion AP pad placement is common in pediatric BLS practice due to defibrillator manufacturer recommendations and hospital protocol. For example, ZOLL® Corp. recommends AP positioning for pads used with the R-series defibrillator. Some evidence suggests advantages for AP placement.6 It has been observed at this institution and others that pediatric nurses often place pads on simulators in the AP position which negates the capability of the HTS to be defibrillated, cardioverted or paced as the pads then have no contact with the studs. Thus, there is a strong desire to train and practice AP pad placement. HTS with AP defibrillation functionality can help to improve training, as it has been shown that omitting the physical practice of steps in training Results in increased likelihood of procedural steps being skipped in practice.7,8 Using this device, HTS with AL functionality can be quickly and reversibly converted to be AP capable. In settings lacking HTS, this device can be used with stand-alone cardiac rhythm generators to teach/train AP defibrillation using LTS. Due to its portability, this device would be exceptionally useful in multiple settings in combination with any available simulator. The device instantly increases the capacity of HTS and provides a low-cost solution to providing realistic resuscitation training focusing on AP placement. References 1. Hunt EA, et al. Delays and errors in cardiopulmonary resuscitation and defibrillation by pediatric residents during simulated cardiopulmonary arrests. Resuscitation 2009; 80(7), 819-825. 2. Donoghue A, et al. Effect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial. Pediatr Emerg Care 2009; 25(3):139-44. 3. Ali J, et al. The standardized live patient and mechanical patient models–their roles in trauma teaching. J Trauma 2009; 66(1):98-102. 4. Owen H, et al. Comparison of three simulation-based training Methods for management of medical emergencies. Resuscitation 2006; 71(2):204-11. Epub 2006 Sep 20. 5. Kory P, et al. Initial airway management skills of senior residents: simulation training compared with traditional training. Chest 2007;132(6):1927-31. Epub 2007 Oct 9. 6. Nagarajan DV, et al. Is antero-posterior position superior to antero-lateral position for placement of electrodes for external cardioversion of atrial fibrillation? Interact CardioVasc Thorac Surg 2004; 3(2): 386-389. 7. Hunt EA, et al. A Prospective, Randomized, Controlled Evaluation of a Contextual In-Hospital BLS Course Versus a Traditional BLS Healthcare Provider Course on Performance in Simulated Cardiac Arrests. AHA Resuscitation Scientific Sessions Poster Presentation 2012. 8. Duval-Arnould J, et al. First-Year Medical Students Acquire Contextually Relevant Cardiopulmonary Resuscitation Knowledge When Exposed to an In-Hospital Focused BLS Course Versus a Traditional Healthcare Provider BLS Course: A Prospective, Randomized, Controlled Evaluation. AHA Resuscitation Scientific Sessions Poster Presentation 2012. Disclosures Laerdal Foundation Grant.