Synergy Pediatric Resuscitation Team Training

Deborah Franzon, MD Clinical Associate Professor Co-Director Mobile Simulation Resuscitation Program Medical Director PICU

Disclosures

• NONE

“the interaction or cooperation of two or more organizations …to produce a combined effect greater than the sum of their separate effects”

The IOM Report June 30th, 2015

“A national responsibility exists to improve the likelihood of survival and favorable neurologic out- comes following a cardiac arrest. This will require immediate changes in cardiac arrest reporting, research, training, and treatment. “

“…hospital providers… must be adequately educated and properly trained to deliver the best possible care in team environ-

ments.”

What we know about training in teams

The challenges of pediatric resuscitation team training

Possible Team Configuration highly variable: > 300,000

Guideline Adherence & Team performance not quantified

PALS Training every 2 years Simulation environment limitations

✓Frequent ✓All team members ✓In own environment ✓Measurable

Low frequency < 50 year High acuity: 40% Survival

Pediatric resident resuscitation skills improve with practice and coaching

E.A. Hunt et al. / Resuscitation 85 (2014) 945–951

3-fold increase }

Gold Standard Time to Initiation of Chest Compressions

In situ mock codes save lives

Andreatta P, et al. Peds Crit Care Med . 12(1) , January 2011, p 33-38.

Mock Codes

Real codes

before

after

Could in situ training of all team members Improve survival and adherence to standard guidelines?

✔

✔

✔

✔

✔

✔

Knight L, et al. Crit Care Med: Volume 42(2) February 2014, p 243-251

Outcome Pre intervention Intervention OR (CI)

Survival to discharge after CPA

50/124 (40.3 %)

28/46 (60.9%)

cOR=2.30 (95% CI, 1.15-4.60)

Adherence to Resuscitation Standard Operating Performance (AHA Guidelines)

38/138 (20.8%)

23/64 (35.9%)

cOR-2.14 (95% CI, 1.15-3.99)

Mean increase in Pediatric Cerebral Performance Category score

0.27 0.11 P = 0.37

Results: Composite, in-situ resuscitation team training improves code team performance and outcomes

Knight L, et al. Crit Care Med: Volume 42(2) February 2014, p 243-251

20%

15%

In situ simulation with debrief uncovers latent Errors

Knight L, et al. Crit Care Med: Volume 42(2) February 2014, p 243-251

Sustaining with hospitalwide Mobile Simulation Resuscitation Program(MSRP) Rotating unit specific

emergency skill training Interprofessional in-situ

mock codes with high fidelity mannekin

Formalized debriefing

Measuring outcomes to track success

• Top 10%ile for Resuscitation Performance

• Codes out of ICU < 2.0 /mo • Surival to discharge after CPA > 50%

Quality

• Decrease escalation of care to ICU Affordability

• Accessible & relevant Service

• Education to >80% of all staff • 20% increase in skill competence

and confidence Innovation/Education

1 year results of a mobile simulation resuscitation program

Quality • Benchmark-top 20%ile • Survival- 42/71 (60%)

Affordability • 20% decrease in RRT transfer to ICU

Service • Unit based champions • MOC for Physicians • Outreach collaboration

Innovation/Education 0%

1%

10%

46%

44%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

DISAGREE

SOMEWHAT DISAGREE

NEUTRAL

AGREE

STRONGLY AGREE

Staff Knowledge—Improved Preparedness for Future Events

N=145

• Future: real time CPR quality feedback WITH SKILLS

Video of mock code

Meet the MSRP Team • Lynda Knight, MS RN

– AHA Instructor, Resuscitation Educator, Co-chair code committee – Program development, implementation and oversight

• Michael Chen, MD – Clinical Associate Professor, Anesthesia – Simulation and technical expertise

• Felice Su, MD – Clinical Assistant Professor, Critical Care – Program content and quality oversight, clinical research

• Ralph Gonzales – Simulation tech – Data and outcomes tracking and monitoring

• Althea Rogers – Research coordinator

• Jessey Bargmann-Losche – Director, Quality Improvement

• Anne McCune – Chief Operatng Officer, LPCH – Executive Sponsor