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