Physicians in Training and Critical Care Nurses Performance in Medical Code Events: Effect of Simulation-Based Training

METHODS:

Subjects:

All internal medicine (IM), emergency medicine (EM), anesthesia (A), surgery (S) residents
and all hospital ICU nurses (approximately 400 subjects) will be undergoing evaluation and
training in CPR techniques according to their department training policy.

Study Assessment Tool:

An objective assessment tool has been developed and tested in medical code scenarios during
training sessions recently done in the simulation lab. The tool has five domains: Airway,
Breathing, Circulation, Communications/Leadership, and Defibrillation. Each domain consists
of 3-8 tasks and skills (attachment A).

Design:

- Phase I: In groups of five to six subjects, residents and nurses will undergo baseline
assessment in CPR techniques in the simulation lab. Subject will be presented with a
clinical scenario that includes cardiopulmonary arrest. Subjects will be scored by
observers based on the previously described assessment tool and will be video recorded.

- Phase II: All study subjects who completed phase I assessment will undergo standardized
debriefing and demonstration of proper CPR techniques after reviewing their individual
baseline videotape followed by repeated demonstration in CPR techniques during a
clinical scenario with cardiopulmonary arrest in the simulation lab. Knowledge
retention will be assessed periodically.

- Phase III: Rates of survival to hospital discharge and survival at 24 hours in
hospitalized patients after cardiopulmonary arrest collected by the CPR committee and
QA department longitudinally for one year after completion of project training (phase
II) will be reviewed and compared to the same period one year earlier (CPR outcome data
are being collected since 2005 at St. Luke's-Roosevelt Hospitals).