Abstract 10327: Protected Mock Codes Using In-situ Simulation in Times of the COVID-19 Pandemic

Introduction: Our hospital faced an uphill battle with increasing clinical emergencies, a surge of patients, and compliance with the new regulations during the COVID-19 pandemic. Thereby, the code blue team developed a protected code blue protocol to minimize the infectious risk of the code team members and provide efficient management of emergencies during a lifesaving situation. Objectives: This project aimed to help the core team members to practice the new protected code blue protocol using in-situ simulation. The drills might improve the self-confidence of the code team members in performing their role, clear identification of themselves, effective communication skills, and teamwork. Methods: The mock code team developed different scenarios and ran the drills in 17 departments in different shifts within 8 weeks. A convenience sample of 269 staff participated in the drills. Participants included physicians, respiratory therapists, nurses, and other disciplinary staff. A debriefing was conducted to identify areas of improvement. Participants completed an evaluation form during the debriefing. The form included questions using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) to rate the variables. Descriptive statistics and the Pearson correlation coefficient were used to test the hypotheses. Results: Out of the 269 participants, 125 staff completed and returned the evaluation form. The mean overall rating of the protected mock codes was 4.184 at a scale from 1 (very poor) to 5 (excellent) with a standard deviation of .827. The Pearson correlation coefficient ( r ) between the overall rating of the training and the amount of self-confidence in performing their role was .697 ( p =.000); clear identification of themselves was .329 ( p = .000); effective communication skills was .500 ( p = .000); and teamwork was .526 ( p = .000). Limitations: The project was conducted in a teaching hospital. The results might not apply to different care delivery settings. Conclusions: The findings of this project demonstrated that in-situ simulation improved the self-confidence of the code team members, communication skills, and teamwork in performing the protected code blue protocol for a COVID-19 suspected or confirmed patient with cardiac arrest.

Abstract 325: Resuscitation Practices in Pediatric Hospitals: Insights From Get with the Guidelines-Resuscitation

Background: Resuscitation practices for adult in-hospital cardiac arrest (IHCA) vary widely, based on setting and size. Resuscitation practices in pediatric hospitals have not been examined in detail, and whether practices differ between free-standing pediatric hospitals and combined hospitals (which care for adults and children) is unknown. Methods: We conducted a survey of U.S. hospitals that submit data on pediatric IHCA to GWTG-Resuscitation, a large national registry of IHCA, to elicit detailed information on resuscitation practices. Hospitals were categorized as free-standing pediatric hospitals and combined hospitals, and rates of resuscitation practices were compared. Results: A total of 33 hospitals with at least 5 IHCA events between 2015-2019 completed the survey, of which 9 (27.3%) were freestanding pediatric hospitals and 24 (72.7%) were combined hospitals. Overall, 18 (54.5%) hospitals used a device to measure chest compression quality, 2 (6.1%) used a mechanical device to deliver chest compressions, 6 (18.2%) routinely monitored diastolic pressures during resuscitations, 16 (48.5%) had a staff member monitor chest compression quality, 10 (30.3%) used lanyards or hats to designate leaders during a resuscitation, 16 (48.5%) routinely conducted immediate code debriefings, and 7 (21.2%) conducted mock codes at least quarterly and 17 (51.5%) reported no set schedule. Freestanding pediatric hospitals were more likely to employ a device to measure chest compressions (88.9% vs. 41.7%; P=0.016), conduct code debriefing always or frequently after resuscitations (77.8% vs. 37.5%, P=0.044), use lanyards or a hat to designate the code team leader during resuscitations (66.7% vs. 16.7%, P=0.006), and allow nurses to defibrillate using an AED (77.8% vs. 29.2%, P=0.01). There were no differences in simulation frequency or other resuscitation practices between the 2 hospital groups. Conclusions: Across hospitals caring for pediatric patients, substantial variation exists in resuscitation practices. For some resuscitation practices, there were differences between freestanding pediatric hospitals and hospitals which care for both adults and children.

Use of In Situ Simulation to Improve Emergency Department Readiness for the COVID-19 Pandemic

Introduction: During the world-wide coronavirus disease 2019 (COVID-19) outbreak, there is an urgent need to rapidly increase the readiness of hospitals. Emergency departments (EDs) are at high risk of facing unusual situations and need to prepare extensively in order to minimize risks to health care providers (HCPs) and patients. In situ simulation is a well-known method used in training to detect system gaps that could threaten safety. Study Objectives: One objective is to identify gaps, test hospital systems, and inform necessary modifications to the standard processes required by patients with COVID-19 presenting at the hospital. The other objective is to improve ED staff confidence in managing such patients, and to increase their skills in basic and advanced airway management and proper personal protective equipment (PPE) techniques. Methods: This is a quasi-experimental study in which 20 unannounced mock codes were carried out in ED resuscitation and isolation rooms. A checklist was designed, validated, and used to evaluate team performances in three areas: donning, basic and advanced airway skills, and doffing. A pre- and post-intervention survey was used to evaluate staff members’ perceived knowledge of ED procedures related to COVID-19 and their airway management skills. Results: A total of 20 mock codes were conducted in the ED. Overall, 16 issues that posed potential harm to staff or patients were identified and prioritized for immediate resolution. Approximately 57.4% of HCPs felt comfortable dealing with suspected/confirmed, unstable COVID-19 cases after mock codes, compared with 33.3% beforehand (P = .033). Of ED HCPs, 44.4% felt comfortable performing airway procedures for suspected/confirmed COVID-19 cases after mock codes compared with 29.6% beforehand. Performance of different skills was observed to be variable following the 20 mock codes. Skills with improved performance included: request of chest x-ray after intubation (88.0%), intubation done by the most experienced ED physician (84.5%), and correct sequence and procedure of PPE (79.0%). Conclusion: Mock codes identified significant defects, most of which were easily fixed. They included critical equipment availability, transporting beds that were too large to fit through doors, and location of biohazard bins. Repeated mock codes improved ED staff confidence in dealing with patients, in addition to performance of certain skills. In situ simulation proves to be an effective method for increasing the readiness of the ED to address the COVID-19 pandemic and other infection outbreaks.

When Telestroke Programs Work, Hospital Size Really Does Not Matter

Background There are still marked disparities in stroke care between rural and urban communities including difference in stroke-related mortality. We analyzed the efficiency of tissue plasminogen activator (tPA) delivery in the spoke sites in our telestroke network to assess impact of telecare in bridging these disparities. Methods We analyzed critical time targets in our telestroke network. These included door-to-needle (DTN) time, door-to-CT (D2CT) time, door-to-call center, door-to-neurocall, and total consult time. We compared these time targets between the larger and smaller spoke hospitals. Results Across all the 52 spokes sites, a total of 825 stroke consults received intravenous tPA. When compared with larger hospitals (>200 beds), the smaller hospital groups with 0 to 25 and 51 to 100 beds had significantly lower D2CT time (p-value 0.01 and 0.005, respectively) and the ones with 26 to 50 and 151 to 200 beds had significantly lower consult time (p-value 0.009 and 0.001, respectively). There was no significant difference in the overall DTN time when all the smaller hospital groups were compared with larger hospitals. Conclusion In our telestroke network, DTN times were not significantly affected by the hospital bed size. This shows that a protocol-driven telestroke network with frequent mock codes can ensure timely administration of tPA even in rural communities regardless of the hospital size and availability of local neurologists.

Improving the Performance of Residents in Pediatric Resuscitation with Frequent Simulated Codes

Aim. Exposure to real codes during pediatric residency training is scarce. Consequently, experiencing mock codes scenarios can provide an opportunity to increase residents’ confidence and knowledge in managing pediatric emergencies. Hypothesis. Pediatric senior residents perform better as code team leaders if they are exposed to frequent mock codes. Material and Methods. Forty-three pediatric senior residents (postgraduate year [PGY] two and three) participated in the study. Team leader performance was assessed utilizing the Team Emergency Assessment Measure (TEAM) scoring. Residents’ team leadership performance was assessed before and 6 months after the implementation of weekly mock codes. Results. Pediatric residents’ team leadership performance in mock codes improved after exposure to weekly practice mock code sessions (71.93 ± 18.50 vs 81.44 ± 11.84, P = 0.01). Conclusion. Increasing the frequency of mock code sessions during residency training led to an improvement in code team leadership performance in pediatric senior residents.

In Situ Neonatal Mock Codes: Assessing the Impact

PurposeTo assess the impact of a quality improvement (QI) project to increase nursing staff confidence in responding to neonatal emergencies.DesignMandatory neonatal emergency in situ scenarios done quarterly.SampleBedside NICU nursing staff and the subset of NICU nurses that attend all high-risk deliveries and neonatal emergencies on the obstetrics unit.Outcome MeasuresConfidence levels in responding to neonatal emergencies, demonstrating neonatal resuscitation skills, and communicating effectively during an emergency.ResultsSixty-eight NICU nurses completed the pre- and postintervention surveys. Self-reported confidence levels increased in all areas measured. Overall, the percentage of nursing staff that reported confidence in being able to participate in a neonatal emergency increased from 48 percent to 77 percent.