Cardiac Clinical Educator Children's Healthcare of Atlanta Buford, Georgia, United States
Abstract: Introduction In 2017, the CICU at Children's Healthcare of Atlanta (CHOA) Heart Center introduced a simulation class that focused on effective teamwork during resuscitations. In 2018, along with a process improvement project, ECPR simulations were implemented to teach the clinical teams the steps needed to safely and efficiently place a patient on ECMO during a resuscitation. Clinical staff in the CICU were required to attend at initial roll-out and attend refresher courses at a cadence based upon number of years worked. After implementing these large projects with the overall goal of improving the team functionality during a resuscitation, the Heart Center’s simulation team created a survey to elicit feedback on how the simulation training impacted real-life situations. Methods In the fall of 2018, surveys were sent to staff members that were part of the ECPR resuscitation team within a week of the event date. Following this, in early 2019, the survey was expanded to include code events where ECPR was not initiated. The survey results were reviewed to identify common themes and gaps in knowledge of how the team worked together such as utilizing closed-loop communication and identifying roles. Reoccurring gaps in knowledge were then used to help create objectives for ongoing team simulation classes. After a year, the simulation team established a multidisciplinary review process for a more in depth review. The multidisciplinary team consisted of an RN, MD, APP, and an ECMO primer. The event review includes a review of survey feedback, vital sign and waveform review, chart documentation, and post-event hot debrief. The information is collated and feedback is given back to the staff that participated in the resuscitation or ECPR event. Summary topics (included closed-loop communication, effective CPR, opportunities for escalation of care…) are shared providing education giving best practice recommendations or referencing applicable policies. Summaries also shared where the review team are escalating any concerns shared in the hot debrief or survey responses. Results To date surveys have been sent for a total of 128 events (ECPR-70, Resuscitation-58) with 84 multidisciplinary event reviews completed. Barriers identified and addressed through this review process include placing step stools on each resuscitation cart in the CICU, creating badges to clearly identify the resuscitation leader, team member mapping for optimal team position, checklists for the ECPR activation process on OR equipment and badges for quick accessibility, and the introduction of a CPR coach to improve effectiveness of basic life support. Conclusions Having an internal resuscitation review team in the CICU that provides feedback after an event has enabled the team to identify areas of opportunity for process improvement, provides a pipeline to have concerns addressed in a timely fashion, and is an avenue to educate staff on current best practices. These outcomes have been beneficial to the CICU at CHOA. This team has expanded their reviews to include resuscitations that occur in other areas of the Heart Center in the cardiac acute care unit and cardiac cath lab, with the hope of identifying and improving system processes of how to resuscitate a patient in these areas.
