The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

USE OF HIGH FIDELITY SIMULATION EDUCATION REDUCES CARDIAC ARRESTS OUTSIDE THE PICU BY 70 PERCENT SINCE INCEPTION AT CHILDREN'S MEDICAL CENTER.

Aleta K. Martin1, Tia A. Tortoriello2,3, Judy LeFlore4,5



Background: Patients are experiencing severe injury or death in pediatric hospitals across the nation because of "failure to rescue". Failure to recognize the deteriorating patient is one of the reasons for these deaths. Using high fidelity simulation training allowed for "real life" situations which increased the floor staff's critical thinking skills which lead to early intervention and prevention of cardiopulmonary arrests outside the intensive care units.

Methods:
The general pediatric unit and the cardiology in-patient units were selected for unannounced mock codes using the high fidelity simulator. The general pediatric unit was identified with inexperienced nursing staff and the cardiology in-patient unit was identified with a lot of codes due to high patient acuity Unit leaders were trained on various mock code scenarios with the use of the simulator prior to the staff's involvement. Additionally the unit leaders were trained to debrief after the code. The unit leaders then conducted mock codes on their unit using a mannequin and an education crash cart. Unit leaders conducted one mock code on each shift every week for the next 8 weeks and an evaluation tool was submitted after each mock code. After the initial unit leader training, a planned mock code using the high-fidelity simulator was performed and feedback was given on performance. Improvements and areas of concern were addressed during the debriefing. Unannounced mock codes for the unit staff using the simulator were conducted and evaluations were submitted to the in-patient managers.

Results:
The cardiology in-patient unit had an 8 % increase in Rapid Response Team activations and the general pediatrics unit had an 83% increase in Rapid Response Team activations. The cardiology unit had a 72% increase in days between codes. The general pediatrics unit had a 50% increase in days between codes. From October 2003 to December 2007 there was a 70% decrease in cardiopulmonary events (p<0.001) / 1,000 patient discharges outside the intensive care units.

Conclusion:
Training staff using the high-fidelity simulated clinical scenarios allows for "real life" situations which would otherwise not be available except during a patient emergency. We decreased respiratory and cardiac arrest events outside the PICU, decreased precipitous PICU admissions from the floors, decreased patient mortality hospital-wide, and increased floor staffs skill in identifying a deteriorating patient.