Education, Research, and Quality Improvement: Education, Research, and Quality Improvement II |

Time to Shock: Does High Fidelity Simulation Improve Early Cardioversion in a Community Hospital Setting? FREE TO VIEW

Kelly Downey, MD; Ahmed Dudar, MD; John Lee, MD
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Geisinger Medical Center, Danville, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):625A. doi:10.1016/j.chest.2016.08.717
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SESSION TITLE: Education, Research, and Quality Improvement II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Practice and systems based improvement have been increasingly applied in all fields of medicine. High fidelity simulation has found many applications, and there is limited evidence that specific outcomes can be improved by simulation training. We propose to look at a particular problem: delay in the time to application of electrical cardioversion in shockable cardiac arrest rhythms. Return of spontaneous circulation(ROSC) correlates with better outcomes in post arrest patients, and early shock increase the likelihood of early ROSC. We suggest that high fidelity simulation with internal medicine residents in a community based hospital will improve times to shock in shockable rhythms.

METHODS: Retrospective chart review was used to identify cardiac arrests with shockable rhythms at a single, large University-affiliated teaching hospital. Code data is recorded in a standardized fashion, which is electronically stored on CodeNet software. Arrests were included if the physician leader was an internal medicine resident. Data collected included resident year, type of arrest, time of identification of shockable rhythm, and time of shock delivered. The pre intervention group consisted of internal medicine residents having received the hospital standard ACLS training. The post intervention consisted of medicine residents having high fidelity critical care case simulations, including simulation of shockable arrest.

RESULTS: 166 cardiac arrests involving shockabe rhythms with internal medicine residents were identified in the stated period, with 91 events falling in the pre-training periods and 75 events in the post training period. Data were summarized as medians in seconds (s) with interquartile range (IQR). Differences in time to shock were assessed by Mann-Whitney U test. Overall, the median time to shock decreased from 49 s (108) to 20 s (58) (p=0.0001).

CONCLUSIONS: Overall, there is a significant correlation between participation in our high fidelity simulation program and earlier administration of shock in shockable cardiac arrest. This suggests that there is an opportunity for intervention in resident training not adressed by standard ACLS training.

CLINICAL IMPLICATIONS: High fidelity simulation offers the opportunity to educate, assess, and provide feedback to training clinicians who may be responsible for leading care of critically ill patients. In the case of cardiac arrests, we know that earlier interventions are key to immediate and long term prognosis. Small improvements in care aimed at return of spontaneous circulation may have significant impact; improving intervention in shockable rhythms is a prime target for improving care. High fidelity simulation is a tool to bridge the gap between theoretical knowledge provided by ACLS, and the actual conditions experienced by house staff in training.

DISCLOSURE: The following authors have nothing to disclose: Kelly Downey, Ahmed Dudar, John Lee

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