Abstract 13198: Impact of Targeted Resident Education on Perceptions of Communication and Participation in Cardiac Arrest

Introduction: Debriefing sessions after in-hospital cardiac arrest have been demonstrated to improve teamwork and survival outcomes. Though recommended in 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, implementation remains low. Hypothesis: We postulated that a didactic training session provided to code leaders would increase rates of participation of AHA-recommended post-arrest debriefing sessions. Methods: Surveys were distributed to hospital personnel who participate in code blue/ERTs at an academic, tertiary-care medical center. Questions were graded on Likert scale to assess provider-reported perceptions of teamwork, communication, and confidence in conducting and participating in Code Blues. Participants were stratified in groups depending on whether they had previously participated in debriefing sessions. Primary outcomes were quantified using a Likert-type scale ranging from 1 to 5. Surveys were compared to surveys from prior years to assess if the intervention of a code blue didactics lecture delivered to code leaders resulted in any change in overall participation rate in the debriefing protocol. Results: Among 181 participants (61% female), 32% were residents, 54% nurses, 1.7% respiratory therapists. Self-evaluated current knowledge of ACLS protocols was significantly higher in the debriefing group (p = 0.0098), while there were no differences in perceived communication (p=0.76), and confidence in leading (p = 0.2) and participating (p = 0.2). We did not find a statistically significant difference in debriefing participation rate after our intervention (57% pre vs 58% post intervention, p=0.8), even when stratified by hospital role: critical care nurses (50% vs 71%, p=0.3), non-ICU nurses (68% vs 57%, p=0.3) and residents (67% vs 50%, p=0.2). Conclusions: Our study demonstrated that participation in post-code debriefing sessions was associated with a statistically significant increase in knowledge of cardiac arrest protocols. A code blue didactics lecture did not result in a statistically significant increase in post-arrest debriefing participation. Further study to elucidate methods to enhance adoption of this crucial, guideline recommended practice is warranted.

Abstract 12580: An Interprofessional Approach to Standardizing Family Care During Code Blue Events

Introduction: The development of a standardized practice for family care during resuscitation (FPDR) events was identified as an area for quality improvement at a large academic hospital. Healthcare Chaplains were identified as ideal Family Facilitators for FPDR due to their professional training in therapeutic communication and existential crisis management as well as their current practice of responding to all Code Blue events. An interprofessional workgroup developed guidelines to delineate the role of Chaplain as Family Facilitator in Code Blue events and created an interprofessional education simulation (IPE-sim) training curriculum for their dissemination. Methods: The workgroup, which included an acute care nurse practitioner in the nursing faculty, a palliative care physician, and the director of Chaplain Services, conducted a thorough review of FPDR literature, analyzed data on Chaplain care provided at Code Blue events over the past 9 years, and entered into dialogue with stakeholders regarding FPDR. The group authored guidelines which were adopted as an addendum to the institution’s existing Code Blue policy. The workgroup collaborated with the Code Blue team to develop simulation training events to ensure proper application of the new guidelines. Results: This work resulted in the addition of FPDR guidelines to the Code Blue policy and the creation of a FPDR flowchart that standardized the Chaplain role in Code Blue events by delineating a communication process as well as FPDR inclusion and exclusion criteria. The implementation of this work was facilitated through three 4-hour IPE-sim training sessions. Conclusions: Standardized FPDR guidelines pertaining to the role of Chaplain as Family Facilitator improve patient- and family-centered care. Institutional FPDR guidelines should be created by an interprofessional team and vetted by multidisciplinary stakeholders. Simulation-enhanced IPE prepares Chaplains and teams for FPDR and can improve interprofessional collaboration during Code Blue events.

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.

A Descriptive Study of Chaplains’ Code Blue Responses

Background Family presence during resuscitation is the compassionate practice of allowing a patient’s family to witness treatment for cardiac or respiratory arrest (code blue event) when appropriate. Offering family presence during resuscitation as an interprofessional practice is consistent with patient- and family-centered care. In many institutions, the role of family facilitator is not formalized and may be performed by various staff members. At the large academic institution of this study, the family facilitator is a member of the chaplain staff. Objectives To examine the frequency of family presence during code blue events and describe the role of chaplains as family facilitators. Methods Chaplain staff documented information about their code responses daily from January 2012 through April 2020. They documented their response time, occurrence of patient death, presence of family at the event, and services they provided. A retrospective data review was performed. Results Chaplains responded to 1971 code blue pages during this time frame. Family members were present at 53% of code blue events. Chaplains provided multiple services, including crisis support, compassionate presence, spiritual care, bereavement support, staff debriefing, and prayer with and for patients, families, and staff. Conclusions Family members are frequently present during code blue events. Chaplains are available to respond to all such events and provide a variety of immediate and longitudinal services to patients, families, and members of the health care team. Their experience in crisis management, spiritual care, and bereavement support makes them ideally suited to serve as family facilitators during resuscitation events.

PROSPECTIVE ANALYSIS OF THE CODE BLUE SYSTEM IN A TERTIARY CARE HOSPITAL

BACKGROUND: This study was an analysis done to ascertain the efciency of the code blue system in a tertiary care hospital. All patients on whom a 'Code Blue' has been called in Command Hospital (Eastern Command) Kolkata from January 2017 to July 2018 were analysed using the standardised Code Blue audit form, maintained by the Department of Anaesthesiology & Critical Care and lled in soon after the Code Blue protocol is run. The primary objective was to analyse the factors associated with survival as well as survival rate along with the issues faced by the Code Blue team.METHODS: Data was collected as per the Code Blue audit form and analysed RESULTS: SPSS software version 22 was used. Pearson Chi Square Test and Cox Regression analysis were used to analyse the data. Atotal of 446 code blue calls were initiated during the period. After excluding 40 False calls and 08 Administrative calls, 398 calls were studied and analysed. Overall survival discharge from ICU was 23.37%. But when patients who had a cardiac arrest at the time of code blue were considered, the survival rate dropped to 5.9%. Factors such as Age, Presenting Rhythm and Duration of CPR were found to have signicant effect on overall survival. Four types of problems were faced during the study – technical, equipment related, crash cart related and staff on duty.CONCLUSION: The study concludes that the code blue system and team is useful in managing patients with a cardiac arrest as well as other medical emergencies. However, there are many lacunae that need to be addressed and more studies are required.