Education, Teaching, and Quality Improvement |

Formalized Resident Training in Code Blue Execution in a Simulation Lab Improves Immediate Post-Code Survival FREE TO VIEW

Adan Mora, MD; Bijas Benjamin, MD; Britton Blough, MD; Bradley Christensen; Jennifer Duewall, MD; Cristie Columbus, MD
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Baylor University Medical Center, Dallas, TX

Chest. 2015;148(4_MeetingAbstracts):462A. doi:10.1378/chest.2253758
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SESSION TITLE: Education and Simulation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: In most teaching institutions, code blue responses are led by a team of residents. Though residents complete Advance Cardiac Life Support (ACLS) training, they rarely receive formal instruction in the practical elements of leading and executing a code blue in the real hospital setting. Code simulation with a SimMan can facilitate formal training in an effort to mimic real life scenarios and improve code blue execution and post-code outcomes.

METHODS: Internal medicine residents at Baylor University Medical Center (BUMC) who respond to all inpatient code blues were trained for a 10-month period in a simulation lab on a 3G version SimMan. Residents were exposed to progressively more challenging arrhythmias and code scenarios in which ACLS was implemented and observed by internal medicine and critical care faculty. Critical feedback and instruction were provided after each session with particular attention to rapid EKG rhythm interpretation, implementation of ACLS interventions, and team leadership skills

RESULTS: An internal review of BUMC’s Code Blue data was conducted. A historical case control of inpatient code blues for 12 months was reviewed and compared to the intervention period of 10 months during which simulation training was implemented. During the historical control period, there were a total of 107 codes for an average of 8.9 codes per month. Immediate post-code survival was noted in 72 codes (67.3%). During the intervention period, there were a total of 180 codes for an average of 16.4 codes per month. Immediate post-code survival was noted in 128 codes (71.1%) for an absolute patient difference of 56 patients. The hospital census during the 22-month study period was stable. Twenty-five patients (23.4%) survived to discharge in the control period versus 40 patients (22.2%) for the intervention period, though this difference was not statistically significant (p-value of .8231).

CONCLUSIONS: Formal resident training in code execution in a simulation lab with a SimMan may improve immediate post-code survival in hospitalized patients. However, the trend seen in immediate post-code survival did not translate survival to discharge. This may be a result of improved ACLS execution of patients in whom successful resuscitation would not have previously been achieved. Further study is needed to determine whether or not observed trend in immediate post-code survival is significant.

CLINICAL IMPLICATIONS: Training programs should evalaute the need for simulation traing in code blues.

DISCLOSURE: The following authors have nothing to disclose: Adan Mora, Bijas Benjamin, Britton Blough, Bradley Christensen, Jennifer Duewall, Cristie Columbus

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