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IN-HOSPITAL CARDIOPULMONARY RESUSCITATION (IHCPR): RESULTS OF A PROGRAM TO IMPROVE TEAM LEADER SKILLS USING A COMPUTERIZED PATIENT SIMULATOR (CPS)

Beth Israel Medical Center, New York, NY

PURPOSE: IHCPR is a low frequency high risk event that requires a well organized team response. We observed specific problems in team leader function during IHCPR in our hospital. We have investigated whether CPS scenario training might improve team leader skills.

METHODS: In July 2004, 31 medicine residents (PGY-3) were divided into 14 groups.(2-3 residents per group) Each group of residents was tested and scored for leader function using a standardized inpatient cardiac arrest scenario. In addition to the residents, 6 other medical housestaff served as actors during each session. Following testing, each resident ran 3 additional arrest scenarios and was debriefed extensively after each scenario. They achieved perfect checklist score (11 essential steps) before the end of training. For 10 months following training, we scored actual IHCPR events to observe for code leader competencies.

RESULTS: Before training, code leader skills were poor when tested with the CPS. For example, only 14% of the residents identified themselves as code leader. None established a "no-go zone" around the patient, and few assigned or monitored function of the airway team and cardiac compression. During actual clinical IHCPR events, code leaders were very effective in achieving many components of the assigned checklist, but we identified several problematic issues; team leaders were not effective in "crowd control"; large numbers of observers/unauthorized personnel were not cleared from around the patient. Also, training was not completely successful in establishing effective behavioral patterns, i.e., some residents could not assume command presence/voice during IHCPR.

CONCLUSION: CPS training for IHCPR leader skill is effective in training certain aspects of task orientated function. However, our future training methods will have to address the challenges of "crowd control" and behavioral patterns which are critical elements of IHCPR.

CLINICAL IMPLICATIONS: Scenario based CPS training seems to be effective in team leader training for well defined tasks during IHCPR. It is less clear that CPS methods can address intrinsic behavioral patterns during combined team training.

DISCLOSURE: Mari Adachi, None.