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Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation |
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| Authors: | Leo Kobayashi David G Lindquist Ilse M Jenouri Kevin M Dushay Elizabeth M Sutton Jessica L Smith Robert J Tubbs Frank L Overly John Foggle Jennifer Dunbar-Viveiros Mark S Jones David L Werner Peggy B Martin Gregory D Jay |
| Institution: | a Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick St., Providence, RI 02903, USA b Rhode Island Hospital Medical Simulation Center, Suite 106, Coro-West Building, 1 Hoppin St., Providence, RI 02903, USA c Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA d Department of Nursing, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA e School of Nursing, University of Nevada Las Vegas, Bigelow Health Sciences 419, 4505 Maryland Parkway, Box 453018, Las Vegas, NV 89154, USA f Lifespan, Suite 2B, Coro Building, 167 Point St., Providence, RI 02903, USA g Division of Internal Medicine, Department of Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA h Department of Bioengineering, Alpert Medical School of Brown University, Box D, 182 Hope St., Providence, RI 02912, USA |
| Abstract: | IntroductionHigh-fidelity medical simulation of sudden cardiac arrest (SCA) presents an opportunity for systematic probing of in-hospital resuscitation systems. Investigators developed and implemented the SimCode program to evaluate simulation's ability to generate meaningful data for system safety analysis and determine concordance of observed results with institutional quality data.MethodsResuscitation response performance data were collected during in situ SCA simulations on hospital medical floors. SimCode dataset was compared with chart review-based dataset of actual (live) in-hospital resuscitation system performance for SCA events of similar acuity and complexity.Results135 hospital personnel participated in nine SimCode resuscitations between 2006 and 2008. Resuscitation teams arrived at 2.5 ± 1.3 min (mean ± SD) after resuscitation initiation, started bag-valve-mask ventilation by 2.8 ± 0.5 min, and completed endotracheal intubations at 11.3 ± 4.0 min. CPR was performed within 3.1 ± 2.3 min; arrhythmia recognition occurred by 4.9 ± 2.1 min, defibrillation at 6.8 ± 2.4 min. Chart review data for 168 live in-hospital SCA events during a contemporaneous period were extracted from institutional database. CPR and defibrillation occurred later during SimCodes than reported by chart review, i.e., live: 0.9 ± 2.3 min (p < 0.01) and 2.1 ± 4.1 min (p < 0.01), respectively. Chart review noted fewer problems with CPR performance (simulated: 43% proper CPR vs. live: 98%, p < 0.01). Potential causes of discrepancies between resuscitation response datasets included sample size and data limitations, simulation fidelity, unmatched SCA scenario pools, and dissimilar determination of SCA response performance by complementary reviewing methodologies.ConclusionOn-site simulations successfully generated SCA response measurements for comparison with live resuscitation chart review data. Continued research may refine simulation's role in quality initiatives, clarify methodologic discrepancies and improve SCA response. |
| Keywords: | Emergency treatment Health care quality improvement Medical emergency team Microsystem Research Resuscitation Simulation Sudden cardiac death |
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