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Monthly High-Fidelity Simulation in Medical Emergencies Improves Survival

Stanford University Medical Center
Stanford, CA

Program Director: Ann Weinacker, MD
Type of Program: Critical Care Medicine
Abstract Authors: Paul K. Mohabir, MD, and Daniel Skully, MD

Medical emergencies, or “code blues,” occur frequently in the hospital and are associated with a high degree of mortality. These situations are often highly chaotic, leading to poor flow of information between team members that might ultimately contribute to the outcome. Additionally, these situations can be highly stressful and do not occur often enough for team members to perform at an optimal level.

We postulated that monthly high-fidelity simulation sessions that include all members of the code team, could help to improve communication between team members and ultimately result in code blues being run more efficiently with improved survival.

We performed monthly high-fidelity code blue simulations at our simulation lab from October 2011 to present day. Sessions includes 2 critical care fellows, 2 crisis nurses, 2 nurses from non-intensive care units, 2 pharmacists, 2 respiratory therapists, and 2-4 medical students. Participants meet in a classroom prior to the simulation to review CPR technique and familiarization with the simulation mannequin. A clinical vignette is initiated with the bedside nurse and all participants clinically manage the cardiac arrest as would be in a real-like situation according to the recent Acute Cardiac Life Saving (ACLS) guidelines. After the simulation, participants return to the classroom to review filmed footage and debrief ACLS algorithms, etiologies of cardiac arrest, and teaching points that are specific to the underlying cause of decompensation in the simulation.

Multivariate logistic regression models revealed that simulation training had a statistically significant improved survival to hospital discharge compared to pre-simulation course survival, OR 1.75 (95% CI=1.68, 1.90).

High-fidelity code blue simulations allow code team members from several disciplines to practice delivery of emergent care in situations without patient risk. Code team members gain experience in communication during chaotic situations, providing high-quality CPR, and improved survival to hospital discharge.

Last Reviewed: December 2016