Abstract
Background
Cardiac arrest is an acute event with very high morbidity and mortality rates. Ten in 1,000 admitted patients go into cardiac arrest each year and only a quarter of these patients survive to hospital discharge. Code environments are highly complex and require expert coordination among participants to improve patient survival. Despite recognition of the necessary elements for successful resuscitation. Time to medical intervention (TMI) and quality of chest compressions are well documented crucial aspects of a successful code, but other qualities such as demonstrative leadership, clear communication, effective team member interaction, and succinct task completion may also contribute to patient outcomes. Clearly identifying the role of each team member, their responsibilities, and bedside position may improve the success of a code situation. Similarly, pre-defined teams consistently outperform ad hoc teams.
Aim
The aim of this project was to decrease the time to medical intervention during mock code situations, improve close loop communication and leadership during a code.
Methods
We achieved our goals by restructuring our code team. First, all members necessary for a code team were identified, their respective roles clearly defined, and the most appropriate bedside positions for each role was carefully selected. Multidisciplinary team leaders were identified and trained as trainers by the core team for this project. Next, random mock codes were called to obtain baseline TMI. After the mock codes for baseline TMI to medical intervention, the trainers then trained the members of their unit on the appropriate roles and specific responsibilities they would be expected to complete during a code situation. Once training was completed, mock codes were randomly called and TMI was recorded. Also, there was a debriefing after these mock codes in which the participants were asked to give their impression of our Quality improvement project on the code team communication, leadership during the mock codes, quietness of the room and their comfort levels with performing the responsibilities of the role they performed. Time to medical intervention in these simulated codes were compared to the average time to medical intervention in our baseline mock codes.
Results
Post-code debriefings revealed a general sense of improved communication, improved crowd control, and clearer leadership when compared to other code situations the participants had been involved in. Similarly, time to shock delivery or medication administration shortened from the prior average of 2 minutes 46 seconds to 2 minutes 3 seconds, a statistically significant improvement (p-value 0.036). Participants also reported clearer communication, better understanding of their role and improved noise in the code environment.
Conclusions
Disorganized codes are costly in terms morbidity and post-arrest care. Having well organized codes with clear roles, responsibilities, and positions may decrease the TMI, communication, noise, leadership and improve patient outcomes. Real-life implementation and analysis of this intervention is needed.
TMI was defined as the time from when a code is called to the time when the first medication or defibrillation was administered which ever was warranted first.