Development of a model to measure the effect of off-balancing vectors on the delivery of high-quality CPR in a moving vehicle.

AIM: We sought to develop a model to measure the acceleration and jerk vectors affecting the performance of High-Quality Cardiopulmonary Resuscitation (HQ-CPR) during patient transport. METHODS: Three participants completed a total of eighteen rounds of compression only HQ-CPR in a moving vehicle. The vehicle was driven in a manner that either minimized or increased linear and angular vectors. The HQ-CPR variables measured were compression fraction (CF%), and percentages of compressions with correct depth > 5 cm (D%), rate 100-120 (R%), full recoil (FR%), and hand position (HP%). A composite HQ-CPR score was calculated: ((D% + R% + FR% + HP%)/4) * CF%). Linear and gyroscopic data were measured in the X, Y, and Z axes. The perceived difficulty in performing HQ-CPR was measured with the Borg Rating of Perceived Exertion Scale. RESULTS: HQ-CPR data, linear vector data, and gyroscopic data were successfully recorded in all trial evolutions. Univariate regression analysis demonstrated that HQ-CPR was negatively affected by increasing magnitudes of linear acceleration (B = -0.093%/m/s2, 95% CI [-0.17 - -0.02), p = 0.02], linear jerk (B = -0.134%/m/s3, 95% CI [-0.26 - -0.01], p = 0.04), angular velocity (B = -0.543%/radian/s, 95% CI [-0.98 - -0.11], p = 0.02), and angular acceleration (B = 0.863%/radian/s2, 95% CI [-1.69 - -0.03], p = 0.04). Increasing vectors were negatively associated with FR% and R%. No difference was seen in D%, HP%, or CF%. Borg Rating of Perceived Exertion was greater in dynamic driving evolutions (8 ± 1 vs 3.5 ± 1.53, p = 0.02). CONCLUSION: This model reliably measured linear and angular off-balancing vectors experienced during the delivery of HQ-CPR in a moving vehicle. In this preliminary report, compression rate and full recoil appear to be HQ-CPR variables most affected in a moving vehicle.

"Good Catch, Kiddo"-Enhancing Patient Safety in the Pediatric Emergency Department Through Simulation.

OBJECTIVES: Adverse events that affect patient safety are a significant concern in pediatrics. Increasing situational awareness, identifying errors and near misses, and reporting them using organizational incident reporting systems enables mitigation of harm. METHODS: We designed and tested a brief, interactive, and easily replicable simulation activity for medical students, and emergency medicine interns and pediatric interns to strengthen their skills and enhance their self-efficacy in identifying and reporting patient safety hazards. Hazards fell into the categories of situational safety, patient identification and privacy, infection prevention, treatment errors, and issues with electronic health records (EHRs). RESULTS: The simulation training significantly increased the self-efficacy of medical students and interns in identifying and reporting patient safety hazards. Learners were very satisfied with the simulation training, successfully recognized key patient safety hazards, provided feedback to improve the training, and improved their ability to report hazards through organizational incident reporting systems. Patient safety hazards associated with patient misidentification were recognized most frequently, whereas safety hazards associated with EHRs were missed with the greatest frequency. CONCLUSIONS: The simulation training enabled learners to identify hazards and near misses and enhanced their ability to report hazards through organizational incident reporting systems. Learners at all levels of training identified safety hazards at comparable rates, which demonstrates the role that trainees play in critically observing clinical settings with fresh eyes and identifying and reporting patient safety hazards. Interventions to promote patient safety need to prioritize building situational awareness of potential hazards associated with EHR use.

Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills.

INTRODUCTION: In hospital cardiac arrest (IHCA) affects 200,000 adults in the United States each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a program of "mock codes" improves group-level performance of IHCA skills. Our primary outcome of interest was change in CPR fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesized that a sustained program of mock codes would translate to greater than 10% improvement in each of these core metrics over the first three years of the program. METHODS: We conducted mock codes in an urban teaching hospital between August, 2012 and October, 2015. Mock codes occurred on telemetry and medical/surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital's "Code Blue" team, and data were recorded by trained observers. Data were summarized using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model. RESULTS: Fifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per six-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly. CONCLUSIONS: While we observed a significant improvement in CPR fraction over the course of this program of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.