Samuel O Clarke1, Ian M Julie1, Aubrey P Yao2, Heejung Bang3, Joseph D Barton4, Sameerah M Alsomali5, Matthew V Kiefer6, Ali Hasan Al Khulaif7, Muna Aljahany8, Sandhya Venugopal9, Aaron E Bair10. 1. Assistant Professor, UC Davis Department of Emergency Medicine. 2. Associate Professor, UC Davis Department of Anesthesia. 3. Professor, UC Davis Division of Biostatistics. 4. Attending Physician, Kaiser Antioch Department of Emergency Medicine, Antioch, California. 5. Assistant Professor, King Saud Bin Abdulaziz University for Health Sciences Department of Emergency Medicine, Riyadh, Saudi Arabia. 6. Attending Physician, St. Joseph's Medical Center, Stockton, California. 7. Consultant of Emergency Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. 8. Assistant Professor, Emergency Medicine Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. 9. Associate Professor, UC Davis School of Medicine. 10. Professor, Emeritus, UC Davis Department of Emergency Medicine.
Abstract
INTRODUCTION: In hospital cardiac arrest (IHCA) affects 200,000 adults in the United States each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a program of "mock codes" improves group-level performance of IHCA skills. Our primary outcome of interest was change in CPR fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesized that a sustained program of mock codes would translate to greater than 10% improvement in each of these core metrics over the first three years of the program. METHODS: We conducted mock codes in an urban teaching hospital between August, 2012 and October, 2015. Mock codes occurred on telemetry and medical/surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital's "Code Blue" team, and data were recorded by trained observers. Data were summarized using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model. RESULTS: Fifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per six-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly. CONCLUSIONS: While we observed a significant improvement in CPR fraction over the course of this program of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.
INTRODUCTION: In hospital cardiac arrest (IHCA) affects 200,000 adults in the United States each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a program of "mock codes" improves group-level performance of IHCA skills. Our primary outcome of interest was change in CPR fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesized that a sustained program of mock codes would translate to greater than 10% improvement in each of these core metrics over the first three years of the program. METHODS: We conducted mock codes in an urban teaching hospital between August, 2012 and October, 2015. Mock codes occurred on telemetry and medical/surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital's "Code Blue" team, and data were recorded by trained observers. Data were summarized using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model. RESULTS: Fifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per six-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly. CONCLUSIONS: While we observed a significant improvement in CPR fraction over the course of this program of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.
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