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Improving Code Team Performance and Survival Outcomes: Implementation of Pediatric Resuscitation Team Training*

Knight, Lynda J. RN, MSN1; Gabhart, Julia M. MD2,3; Earnest, Karla S. MS, MSN4; Leong, Kit M. RHIT, CPHQ5; Anglemyer, Andrew PhD6; Franzon, Deborah MD7

doi: 10.1097/CCM.0b013e3182a6439d
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Objective: To determine whether implementation of Composite Resuscitation Team Training is associated with improvement in survival to discharge and code team performance after pediatric in-hospital cardiopulmonary arrest.

Design, Setting, and Subjects: We conducted a prospective observational study with historical controls at a 302-bed, quaternary care, academic children’s hospital. Inpatients who experienced cardiopulmonary arrest between January 1, 2006, and December 31, 2009, were included in the control group (123 patients experienced 183 cardiopulmonary arrests) and between July 1, 2010, and June 30, 2011, were included in the intervention group (46 patients experienced 65 cardiopulmonary arrests).

Intervention: Code team members were introduced to Composite Resuscitation Team Training and continued training throughout the intervention period (January 1, 2010–June 30, 2011). Training was integrated via in situ code blue simulations (n = 16). Simulations were videotaped and participants were debriefed for education and process improvement. Primary outcome was survival to discharge after cardiopulmonary arrest. Secondary outcome measures were 1) change in neurologic morbidity from admission to discharge, measured by Pediatric Cerebral Performance Category, and 2) code team adherence to resuscitation Standard Operating Performance variables.

Measurements and Main Results: The intervention group was more likely to survive than the control group (60.9% vs 40.3%) (unadjusted odds ratio, 2.3 [95% CI, 1.15–4.60]) and had no significant change in neurologic morbidity (mean change in Pediatric Cerebral Performance Category 0.11 vs 0.27; p = 0.37). Code teams exposed to Composite Resuscitation Team Training were more likely than control group to adhere to resuscitation Standard Operating Performance (35.9% vs 20.8%) (unadjusted odds ratio, 2.14 [95% CI, 1.15–3.99]). After adjusting for adherence to Standard Operating Performance, survival remained improved in the intervention period (odds ratio, 2.13 [95% CI, 1.06–4.36]).

Conclusion: With implementation of Composite Resuscitation Team Training, survival to discharge after pediatric cardiopulmonary arrest improved, as did code team performance. Demonstration of improved survival after adjusting for code team adherence to resuscitation standards suggests that this may be a valuable resuscitation training program. Further studies are needed to determine causality and generalizability.

1Center for Nursing Excellence, Lucile Packard Children’s Hospital, Palo Alto, CA.

2Department of Pediatrics, Lucile Packard Children’s Hospital, Palo Alto, CA.

3Department of Pediatrics, Stanford University, Palo Alto, CA.

4Division of Trauma Services, Department of Pediatrics, Lucile Packard Children’s Hospital, Palo Alto, CA.

5Center for Quality Effectiveness and Process Improvement, Lucile Packard Children’s Hospital, Palo Alto, CA.

6Division of Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.

7Division of Pediatric Critical Care, Department of Pediatrics, Lucile Packard Children’s Hospital, Palo Alto, CA.

* See also p. 446.

This work was performed in the Lucile Packard Children’s Hospital at Stanford.

Supported, in part, by Lucile Packard Children’s Hospital Innovations and Patient Care Grant.

Ms. Knight’s institution received grant support: an Innovation in Patient Care Grant at Lucile Packard Children’s Hospital at Stanford. Dr. Gabhart is employed as a pediatric hospitalist by Stanford University and by Palo Alto Medical Foundation. She received support for article research and for review activities from the Lucile Packard Foundation for Children’s Health (LPCH) Innovations. Her institution received grant support from the Lucile Packard Foundation (grant helped fund this study). Ms. Earnest is employed by LPCH. Her institution received grant support from LPCH Innovations in Patient Care Grant. Ms. Leong’s institution received grant support from IPC grant. Dr. Anglemyer was compensated for lecture and manuscript work as a researcher at Stanford University. Dr. Franzon lectured for Dominican Hospital (2011 Resuscitation Update for locally sponsored symposium) and received support for travel from REACH Air Medical Services (2011 and 2012 sponsored travel to local/regional transport symposium).

Address requests for reprints to: Lynda J. Knight, RN, MSN, 4700 Bohannon Drive #147, Menlo Park, CA 94025. E-mail: lyknight@lpch.org

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins