Calming the Chaos: Simulated Code Training
Calming the Chaos: Simulated Code Training
The Clinical Teamwork Scale used to measure elements of CRM uses a 0-to-10 scale for all categories (with 0 indicating poor and 10 indicating perfect). Baseline scores from 2009 ranged from 4 to 5.79 (average). After 2 years of training, all scores showed statistically significant improvements from baseline.
The critical action scale used to measure adherence to ACLS revealed that the code blue team correctly identified the cardiac rhythm 94% of the time—a significant improvement from a baseline adherence of 71% (p = .01). In addition, the team recognized the need for prompt defibrillation 82% of the time, compared to 47% at baseline (p = .005).
Simulation provides an excellent opportunity to mimic the intensity of critical events by practicing cognitive, technical, and behavioral skills with hands-on, real-time team training in a safe environment. At OHSU, SCITT has contributed to improved clinical and team-based performance as measured in mock codes over time.
System-level improvements have been identified through training, such as documentation, code-cart contents (based on practice and feedback), and the need for additional training on new equipment. The program has led to institutional support for RN code blue team members to function as code team leaders if they arrive on the scene before the physician code leader.
However, planning and facilitating SCITTs are time- and resource-intensive. Filling all the interdisciplinary roles to run a SCITT has been a challenge, especially on the night shift. We plan to continue twice-monthly SCITTs and have increased the scenario complexity based on actual case reviews from the code blue committee. We now have scenarios that incorporate a ventricular assist device, tracheotomy, pregnancy, massive hemorrhage, and ICU code blues. This project is approved by the institutional review board. We're collecting data from actual code blue events to confirm that the training has translated to improved teamwork and clinical accuracy.
Improvements Over Time
The Clinical Teamwork Scale used to measure elements of CRM uses a 0-to-10 scale for all categories (with 0 indicating poor and 10 indicating perfect). Baseline scores from 2009 ranged from 4 to 5.79 (average). After 2 years of training, all scores showed statistically significant improvements from baseline.
The critical action scale used to measure adherence to ACLS revealed that the code blue team correctly identified the cardiac rhythm 94% of the time—a significant improvement from a baseline adherence of 71% (p = .01). In addition, the team recognized the need for prompt defibrillation 82% of the time, compared to 47% at baseline (p = .005).
Simulation provides an excellent opportunity to mimic the intensity of critical events by practicing cognitive, technical, and behavioral skills with hands-on, real-time team training in a safe environment. At OHSU, SCITT has contributed to improved clinical and team-based performance as measured in mock codes over time.
System-level improvements have been identified through training, such as documentation, code-cart contents (based on practice and feedback), and the need for additional training on new equipment. The program has led to institutional support for RN code blue team members to function as code team leaders if they arrive on the scene before the physician code leader.
However, planning and facilitating SCITTs are time- and resource-intensive. Filling all the interdisciplinary roles to run a SCITT has been a challenge, especially on the night shift. We plan to continue twice-monthly SCITTs and have increased the scenario complexity based on actual case reviews from the code blue committee. We now have scenarios that incorporate a ventricular assist device, tracheotomy, pregnancy, massive hemorrhage, and ICU code blues. This project is approved by the institutional review board. We're collecting data from actual code blue events to confirm that the training has translated to improved teamwork and clinical accuracy.
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