Akwe Joyce
Department of Medicine Emory University School of Medicine.
Department of Medicine Atlanta VA Health Care System/VISN 7 CRH.
J Brown Hosp Med. 2024 Oct 1;3(4):36-40. doi: 10.56305/001c.123597. eCollection 2024.
Cardiac arrest is a prevalent event with low survival rates, both in out-of-hospital and in-hospital settings. There is a lack of specific training programs addressing team dynamics and leadership skills during resuscitation events, creating a clinical gap. This project aimed to enhance team dynamics and improve leadership skills during IHCA resuscitation events.
We implemented the Mock Code Project for resident physicians from our Internal Medicine Residency Programs in the simulation center (i.e., in a controlled environment) to address this gap. Multidisciplinary team mock code scenarios were created for residents, allowing them to lead resuscitation simulations. The scenarios were based upon common conditions encountered during codes (Cardiac arrest). Trained evaluators provided real-time feedback, and pre-and post-surveys were conducted to assess team perception and gather feedback.
Baseline data revealed that 98.6% (143 of 145 residents total) felt uncertain or lacked confidence in leading effective codes in our hospital prior to the intervention. Post-test survey outcome data revealed that 95.1% of participants (136 residents of 143) reported that the sessions challenged their skills at leading codes and improved their skills at managing resuscitation teams.
Organized codes with clear roles, responsibilities, bed positioning, and clear leadership significantly improve closed-loop communication, effective team interaction, and patient outcomes. The Mock Code Project fills the gap in training programs by focusing on team dynamics and leadership skills during IHCA resuscitation. Ongoing evaluations and feedback ensure continual improvement in resident confidence and skills. Implementing organized codes benefits residents and healthcare teams, ultimately improving patient care during IHCA. Well-designed mock code scenarios with real-time feedback from senior physicians are an effective way for trainees to develop these skills and this awareness without compromising patient safety.
心脏骤停是一种常见事件，在院外和院内环境中的生存率都很低。在复苏过程中，缺乏针对团队协作和领导技能的特定培训项目，这造成了临床差距。本项目旨在增强院内心脏骤停（IHCA）复苏过程中的团队协作并提高领导技能。
我们在模拟中心（即受控环境）为内科住院医师培训项目的住院医师实施了模拟急救项目，以弥补这一差距。为住院医师创建了多学科团队模拟急救场景，让他们领导复苏模拟。这些场景基于急救过程中常见的情况（心脏骤停）。训练有素的评估人员提供实时反馈，并进行前后调查以评估团队认知并收集反馈。
基线数据显示，在干预前，98.6%（共145名住院医师中的143名）的人对在我院领导有效的急救过程感到不确定或缺乏信心。测试后调查结果数据显示，95.1%的参与者（143名中的136名住院医师）报告称，这些课程挑战了他们领导急救的技能，并提高了他们管理复苏团队的技能。
具有明确角色、职责、床位摆放和明确领导的有组织的急救显著改善了闭环沟通、有效的团队互动和患者预后。模拟急救项目通过关注IHCA复苏过程中的团队协作和领导技能，填补了培训项目的空白。持续的评估和反馈确保住院医师的信心和技能不断提高。实施有组织的急救对住院医师和医疗团队有益，最终改善IHCA期间的患者护理。设计良好的模拟急救场景并得到资深医生的实时反馈，是学员在不危及患者安全的情况下培养这些技能和意识的有效方法。
