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Jeong HW, Moon SH. Enhancing ACLS training effects through video-assisted boosting methods: A comparative analysis of self-simulation and model simulation videos. Nurse Educ Pract 2024; 78:104010. [PMID: 38843687 DOI: 10.1016/j.nepr.2024.104010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 05/12/2024] [Accepted: 05/26/2024] [Indexed: 07/08/2024]
Abstract
AIMS To assess the impact of learner-participation and instructor-led simulation videos on nurses' CPR skills, focusing on iterative learning to boost proficiency in ACLS. BACKGROUND Advanced cardiac life support (ACLS) training is crucial for nurses, especially to improve cardiopulmonary resuscitation (CPR) proficiency, for which an effective training strategy is needed. DESIGN A quasi-experimental, pretest-posttest design was implemented to assess the impact of self-simulation and model simulation videos on sustaining CPR education. METHODS The research was carried out at a university hospital in Korea from August 2021 to July 2022. A total of 110 nurses were allocated into three groups based on the building of their workplace in the hospital. Each group watched training videos at 4-month intervals after the simulation training. The self-video group viewed simulations featuring their participation, while the model video group watched instructor-led simulations. A comparison group participated in the simulations without subsequent video boosting. RESULTS Both the self-video and model video groups exhibited significantly superior ACLS performance compatred with the comparison group at both four months (H = 70.33, p <.001) and eight months (H = 81.52, p <.001) following the intervention, with large effect sizes (self-video vs. comparison: d = 4.73 at four months, d = 12.54 at eight months; model video vs. comparison: d = 4.53 at four months, d = 11.01 at eight months). ACLS knowledge scores also significantly increased over time in both intervention groups (self-video: χ² = 22.09, p <.001; model video: χ² = 24.13, p <.001), but not in the comparison group (χ² = 3.75, p =.153). There were no significant differences among the groups in terms of CPR self-efficacy or stress at either time point. CONCLUSION Supplementary training using simulation videos is an effective method for maintaining and enhancing nurses' ACLS competency, offering a sustainable approach to repetitive CPR training. This study underscores the value of incorporating recorded simulation videos in clinical training, offering insights into efficient methods for continuous learning and CPR proficiency among nursing professionals.
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Affiliation(s)
- Hye Won Jeong
- Department of Nursing, Korea National University of Transportation, Jeungpyeong, South Korea.
| | - Sun-Hee Moon
- College of Nursing, Chonnam National University, Gwangju, South Korea.
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Haynes JC, Rettedal SI, Ushakova A, Perlman JM, Ersdal HL. How Much Training Is Enough? Low-Dose, High-Frequency Simulation Training and Maintenance of Competence in Neonatal Resuscitation. Simul Healthc 2024:01266021-990000000-00112. [PMID: 38445834 DOI: 10.1097/sih.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care providers (HCPs) involved in newborn resuscitation. The aim of this study was to identify the optimal frequency and dose of simulation training to maintain this competence level. METHODS Prospective observational study of HCPs training through 9 months. All training was logged. Overall ventilation competence scores were calculated for each simulation case, incorporating 7 skill elements considered important for effective ventilation.Overall scores and skill elements were analyzed by generalized linear mixed effects models using frequency (number of months of 9 where training occurred and total number of training sessions in 9 months) and dose (total number of cases performed) as predictors. Training loads (frequency + dose) predictive of high scores were projected based on estimated marginal probabilities of successful outcomes. RESULTS A total of 156 HCPs performed 4348 training cases. Performing 5 or more sessions in 9 months predicted high global competence scores (>28/30). Frequency was the best predictor for 4 skill elements; success in maintaining airway patency and ventilation fraction was predicted by performing training in, respectively, 2 and 3 months of 9, whereas for avoiding dangerously high inflating pressures and providing adequate mask seal, 5 and 6 sessions, respectively, over the 9 months, predicted success. Skills reflecting global performance (successful resuscitation and valid ventilations) and ventilation rate were more dose-dependent. CONCLUSIONS Training frequency is important in maintaining neonatal ventilation competence. Training dose is important for some skill elements. This offers the potential for individualized training schedules.
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Affiliation(s)
- Joanna C Haynes
- From the Department of Anaesthesia (J.C.H., H.L.E.), Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences (J.C.H., S.I.R., H.L.E.), University of Stavanger, Stavanger, Norway; Department of Paediatrics (S.I.R.), Stavanger University Hospital, Stavanger, Norway; Department of Biostatistics (A.U.), Stavanger University Hospital, Stavanger, Norway; and Department of Pediatrics (J.M.P.), Weill Cornell Medicine, New York, NY
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Claesson A, Hult H, Riva G, Byrsell F, Hermansson T, Svensson L, Djärv T, Ringh M, Nordberg P, Jonsson M, Forsberg S, Hollenberg J, Nord A. Outline and validation of a new dispatcher-assisted cardiopulmonary resuscitation educational bundle using the Delphi method. Resusc Plus 2024; 17:100542. [PMID: 38268848 PMCID: PMC10805935 DOI: 10.1016/j.resplu.2023.100542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024] Open
Abstract
Aim Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is time-dependent. To date, evidence-based training programmes for dispatchers are lacking. This study aimed to reach expert consensus on an educational bundle content for dispatchers to provide DA-CPR using the Delphi method. Method An educational bundle was created by the Swedish Resuscitation Council consisting of three parts: e-learning on DA-CPR, basic life support training and audit of emergency out-of-hospital cardiac arrest calls. Thereafter, a two-round modified Delphi study was conducted between November 2022 and March 2023; 37 experts with broad clinical and/or scientific knowledge of DA-CPR were invited. In the first round, the experts participated in the e-learning module and answered a questionnaire with 13 closed and open questions, whereafter the e-learning part of the bundle was revised. In the second round, the revised e-learning part was evaluated using Likert scores (20 items). The predefined consensus level was set at 80%. Results Delphi rounds one and two were assessed by 20 and 18 of the invited experts, respectively. In round one, 18 experts (18 of 20, 90%) stated that they did not miss any content in the programme. In round two, the scale-level content validity index based on the average method (S-CVI/AVE, 0.99) and scale-level content validity index based on universal agreement (S-CVI/UA, 0.85) exceeded the threshold level of 80%. Conclusion Expert consensus on the educational bundle content was reached using the Delphi method. Further work is required to evaluate its effect in real-world out-of-hospital cardiac arrest calls.
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Affiliation(s)
- Andreas Claesson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Håkan Hult
- Department of Healthcare, Clinicum, Linköping University Hospital, Sweden
| | - Gabriel Riva
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Fredrik Byrsell
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Thomas Hermansson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Ringh
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Per Nordberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Sune Forsberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anette Nord
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Pedersen BBB, Lauridsen KG, Langsted ST, Løfgren B. Organization and training for pediatric cardiac arrest in Danish hospitals: A nationwide cross-sectional study. Resusc Plus 2024; 17:100555. [PMID: 38586865 PMCID: PMC10995645 DOI: 10.1016/j.resplu.2024.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Background Improving survival from pediatric cardiac arrest requires a well-functioning system of care with appropriately trained healthcare providers and designated cardiac arrest teams. This study aimed to describe the current organization and training for pediatric cardiac arrest in Denmark. Methods We performed a nationwide cross-sectional study. A questionnaire was distributed to all hospitals in Denmark with a pediatric department. The survey included questions about receiving patients with out-of-hospital cardiac arrest, protocols for extracorporeal life support, cardiac arrest team compositions, and training. Results We obtained responses from 17 of 19 hospitals with a pediatric department. In total, 76% of hospitals received patients with pediatric out-of-hospital cardiac arrest and 35% of hospitals had a protocol for extracorporeal life support. None of the hospitals had identical cardiac arrest team member compositions. The total number of team members ranged from 4-10, with a median of 8 members (IQR 7;9). In 84% of hospitals a specialized course in pediatric resuscitation was implemented and in 5% of hospitals, the specialized course was for the entire cardiac arrest team. Only few hospitals had training in laryngeal mask (6%) and intubation (29%) for pediatric cardiac arrest and none of them were trained in extracorporeal life support. Conclusion We found high variability in the composition of the pediatric cardiac arrest teams and training across the surveyed Danish hospitals. Many hospitals lack training in important pediatric resuscitation skills. Although many hospitals receive pediatric patients after out-of-hospital cardiac arrest, only few have protocols for transfer for extracorporeal life support.
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Affiliation(s)
- Bea Brix B. Pedersen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Medicine, Randers Regional Hospital, Denmark
| | - Kasper G. Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Medicine, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Sandra Thun Langsted
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Emergency Medicine, Randers Regional Hospital, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Medicine, Randers Regional Hospital, Denmark
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Meaney PA, Hokororo A, Ndosi H, Dahlen A, Jacob T, Mwanga JR, Kalabamu FS, Joyce CL, Mediratta R, Rozenfeld B, Berg M, Smith ZH, Chami N, Mkopi N, Mwanga C, Diocles E, Agweyu A. Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains. BMJ Open 2024; 14:e077834. [PMID: 38309746 PMCID: PMC10840034 DOI: 10.1136/bmjopen-2023-077834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/09/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition. METHODS 6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. RESULTS aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1-9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%-63%), unconscious-incompetence 32% (IQR: 23%-42%), conscious-incompetence 7% (IQR: 2%-15%), and unconscious-competence 2% (IQR: 0%-3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity. CONCLUSION aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.
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Affiliation(s)
- Peter Andrew Meaney
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Critical Care, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Adolfine Hokororo
- Pediatrics and Child Health, Bugando Consultant and Referral Hospital, Mwanza, Tanzania
- Pediatrics and Child Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Hanston Ndosi
- Pediatrics and Child Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Alex Dahlen
- New York University Division of Biostatistics, New York, New York, USA
| | | | - Joseph R Mwanga
- Epidemiology, Biostatistics, and Behavioural Sciences School of Public Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | | | - Christine Lynn Joyce
- Critical Care, Cornell University Department of Pediatrics, New York, New York, USA
| | - Rishi Mediratta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Marc Berg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Critical Care, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Zachary Haines Smith
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Neema Chami
- Pediatrics and Child Health, Bugando Consultant and Referral Hospital, Mwanza, Tanzania
- Pediatrics and Child Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Namala Mkopi
- Pediatric Critical Care, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Enock Diocles
- Nursing, Mwanza College of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambrose Agweyu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Institute, Nairobi, Kenya
- London School of Hygiene & Tropical Medicine, London, UK
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Smith SE, Sikora AN, Fulford M, Rogers KC. Long-Term Retention of Advanced Cardiovascular Life Support Knowledge and Confidence in Doctor of Pharmacy Students. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100609. [PMID: 37866521 DOI: 10.1016/j.ajpe.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of American Heart Association (AHA) advanced cardiovascular life support (ACLS) education and training on long-term retention of ACLS knowledge and confidence in Doctor of Pharmacy (PharmD) students. METHODS This multicenter study included PharmD students who received ACLS training through different means: 1-hour didactic lecture (didactic), 1-hour didactic lecture with 2-hour skills practice (didactic + skills), and comprehensive AHA ACLS certification through an elective course (elective-certification). Students completed a survey before training, immediately after training, and at least 6-12 months after training to assess demographics and ACLS confidence and knowledge. The primary outcome was a passing score, defined as ≥ 84% on the long-term knowledge assessment. Secondary outcomes included overall knowledge score and perceived confidence, assessed using the Dreyfus model. RESULTS The long-term assessment was completed by 160 students in the didactic group, 66 in the didactic + skills group, and 62 in the elective-certification group. Six (4%), 8 (12%), and 14 (23%) received a passing score on the long-term knowledge assessment in the didactic, didactic + skills, and elective-certification groups, respectively. The median (IQR) scores on the long-term knowledge assessment were 50% (40-60), 60% (50-70), and 65% (40-80) in the 3 groups. On the long-term assessment, confidence was higher in the elective-certification group, demonstrated by more self-ratings of competent, proficient, and expert, and fewer self-ratings of novice and advanced beginner. CONCLUSION Long-term retention of ACLS knowledge was low in all groups, but was higher in students who received AHA ACLS certification through an ACLS elective course.
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Affiliation(s)
- Susan E Smith
- University of Georgia College of Pharmacy, Athens, GA, USA.
| | | | | | - Kelly C Rogers
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
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Chan PS, Greif R, Anderson T, Atiq H, Bittencourt Couto T, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Kah-Lai Leong C, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mustafa Mohamed MT, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Odakha JA, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Nallamothu BK. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Resuscitation 2023; 193:109996. [PMID: 37942937 PMCID: PMC10769812 DOI: 10.1016/j.resuscitation.2023.109996] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Paul S Chan
- Mid-America Heart Institute, Kansas City, MO, United States.
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan
| | | | | | - Allan R De Caen
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Canada
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA, United States
| | - Matthew J Douma
- Department of Critical Care Medicine, University of Alberta, Canada
| | - Dana P Edelson
- Department of Medicine, University of Chicago Medicine, IL, United States
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China
| | - Judith C Finn
- School of Nursing, Curtin University, Perth, Australia
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica, United States
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, United States
| | | | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Peter T Morley
- Department of Intensive Care, The University of Melbourne, Australia
| | - Laurie J Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY, United States
| | | | | | | | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, United States
| | | | | | - Theresa M Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia
| | | | | | | | | | | | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
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Nallamothu BK, Greif R, Anderson T, Atiq H, Couto TB, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Leong CKL, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mohamed MTM, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Athieno Odakha J, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Chan PS. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Circ Cardiovasc Qual Outcomes 2023; 16:e010491. [PMID: 37947100 PMCID: PMC10659256 DOI: 10.1161/circoutcomes.123.010491] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland (R.G.)
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor (B.K.N., T.A.)
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan (H.A.)
| | | | | | - Allan R. De Caen
- Division of Pediatric Critical Care, Stollery Children’s Hospital, Edmonton, Canada (A.R.D.C.)
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden (T.D.)
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA (A.D.)
| | - Matthew J. Douma
- Department of Critical Care Medicine, University of Alberta, Canada (M.J.D.)
| | - Dana P. Edelson
- Department of Medicine, University of Chicago Medicine, IL (D.P.E.)
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China (F.X.)
| | - Judith C. Finn
- School of Nursing, Curtin University, Perth, Australia (J.F.)
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica (G.F.)
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (S.G.)
| | | | - Carrie Kah-Lai Leong
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Peter T. Morley
- Department of Intensive Care, The University of Melbourne, Australia (P.T.M.)
| | - Laurie J. Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada (L.J.M.)
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY (A.M.)
| | | | | | | | - Vinay M. Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA (V.N.)
| | - Robert W. Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor (R.W.N.)
| | - Jerry P. Nolan
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | - Theresa M. Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway (T.M.O.)
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia (J.O.)
| | - Gavin D. Perkins
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | | | | | | | - Paul S. Chan
- Mid-America Heart Institute, Kansas City, MO (P.S.C.)
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Tuyishime E, Mossenson A, Livingston P, Irakoze A, Seneza C, Ndekezi JK, Skelton T. Resuscitation team training in Rwanda: A mixed method study exploring the combination of the VAST course with Advanced Cardiac Life Support training. Resusc Plus 2023; 15:100415. [PMID: 37363124 PMCID: PMC10285628 DOI: 10.1016/j.resplu.2023.100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction The influence of non-technical skills training on resuscitation performance in low-resource settings is unknown. This study investigates combining the Vital Anaesthesia Simulation Training Course with Advanced Cardiac Life Support training on resuscitation performance in Rwanda. Methods Participants in this mixed method study are members of resuscitation teams in three district hospitals in Rwanda. The intervention was participation in a 2-day Advanced Cardiac Life Support course followed by the 3-day Vital Anaesthesia Simulation Training Course. Quantitative primary endpoints were time to initiation of cardiopulmonary resuscitation, time to epinephrine administration, and time to defibrillation. Qualitative data on workplace implementation were gathered during focus groups held 3-months post-intervention. Results Forty-seven participants were recruited. Quantitative data showed a statistically significant decrease in time to cardiopulmonary resuscitation, epinephrine administration, and defibrillation from pre- to post-Advanced Cardiac Life Support, with times of [43.3 (49.7) seconds] versus [16.5 (20) sec], p = <0.001; [137.3 (108.9) sec] versus [51.3 (37.9)], p = <0.001; and [218.5 (105.8) sec] versus [110.8 (87.1) sec], p = <0.001; respectively. These improvements were maintained following the Vital Anaesthesia Simulation Training Course, and at 3-month retention testing. Qualitative analysis highlighted five key themes: ability to initiate cardiopulmonary resuscitation; team coordination for task allocation; empowerment; desire for training and mentorship; and advocacy for system improvement. Conclusion A modified 2-day Advanced Cardiac Life Support course improved resuscitation time indicators with retention 3-months later. Combining the Vital Anaesthesia Simulation Training Course and Advanced Cardiac Life Support led to better team coordination, empowerment to act, and advocacy for system improvement. This pairing of courses has promise for improving Advanced Cardiac Life Support skills amongst healthcare workers in low-resource settings.ClinicalTrials.gov Identifier: NCT05278884.
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Affiliation(s)
- Eugene Tuyishime
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
- Department Anesthesia and Critical Care, University of Botswana, Botswana
- Department of Anesthesia and Perioperative Medicine, Western University, Ontario, Canada
| | - Adam Mossenson
- Department of Anaesthesia, SJOG Public and Private Hospital, Perth, Western Australia
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Nova Scotia, Canada
- Curtin University, Perth, Western Australia, Australia
| | - Patricia Livingston
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Nova Scotia, Canada
| | - Alain Irakoze
- Department Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Rwanda
| | | | | | - Teresa Skelton
- Department of Anesthesia and Pain Medicine, the Hospital for Sick Children, University of Toronto, Canada
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10
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Meaney P, Hokororo A, Ndosi H, Dahlen A, Jacob T, Mwanga JR, Kalabamu FS, Joyce C, Mediratta R, Rozenfeld B, Berg M, Smith Z, Chami N, Mkopi NP, Mwanga C, Diocles E, Agweyu A. Feasibility of an Adaptive E-Learning Environment to Improve Provider Proficiency in Essential and Sick Newborn Care in Mwanza, Tanzania. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.11.23292406. [PMID: 37502852 PMCID: PMC10370233 DOI: 10.1101/2023.07.11.23292406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Introduction To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment (AEE). The objectives of this study were to 1) assess implementation success with use of in-person support and nudging strategy and 2) describe baseline provider knowledge and metacognition. Methods 6-month observational study at 1 zonal hospital and 3 health centers in Mwanza, Tanzania. To assess implementation success, we used the RE-AIM framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. Results aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing, and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centers. Median clinical experience was 4 years [IQR 1,9] and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD±17%). Providers averaged 78% (SD±31%) completion of initial learning and 7%(SD±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% [IQR:38-63%], unconscious-incompetence 32% [IQR:23-42%], conscious-incompetence 7% [IQR:2-15%], and unconscious-competence 2% [IQR:0-3%]. Higher baseline conscious-competence (OR 31.6 [95%CI:5.8, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to medical officer) were associated with initial learning completion or persistent activity. Conclusion aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning, and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalization is needed.
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Affiliation(s)
- Peter Meaney
- Stanford University School of Medicine, Palo Alto, CA
| | - Adolfine Hokororo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Hanston Ndosi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Alex Dahlen
- Stanford University School of Medicine, Palo Alto, CA
| | | | - Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Florence S Kalabamu
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Christine Joyce
- Cornell University School of Medicine, New York, New York USA
| | | | | | - Marc Berg
- Stanford University School of Medicine, Palo Alto, CA
- Area9 Lyceum, Boston, Massachusetts, USA
| | - Zack Smith
- Stanford University School of Medicine, Palo Alto, CA
| | - Neema Chami
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Namala P Mkopi
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Castory Mwanga
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Enock Diocles
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambrose Agweyu
- KEMRI-Wellcome Trust Research Programme, Kenya
- London School of Hygiene and Tropical Medicine, London, UK
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11
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Waldolf R, Dion PM, Bould D, Bould C, Crnic A, Etherington C, McBride G, Boet S. The timing of booster sessions may not improve resuscitation skill retention among healthcare providers: a randomized controlled trial. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:99-106. [PMID: 37465730 PMCID: PMC10351636 DOI: 10.36834/cmej.74401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Introduction Booster sessions can improve cardiopulmonary resuscitation (CPR) skill retention among healthcare providers; however, the optimal timing of these sessions is unknown. This study aimed to explore differences in skill retention based on booster session timing. Methods After ethics approval, healthcare providers who completed an initial CPR training course were randomly assigned to either an early booster, late booster, or no booster group. Participants' mean resuscitation scores, time to initiate compressions, and time to successfully provide defibrillation were assessed immediately post-course and four months later using linear mixed models. Results Seventy-three healthcare professionals were included in the analysis. There were no significant differences by randomization in the immediate post-test (9.7, 9.2, 8.9) or retention test (10.2, 9.8, and 9.5) resuscitation scores. No significant effects were observed for time to compression. Post-test time to defibrillation (mean ± SE: 112.8 ± 3.0 sec) was significantly faster compared to retention (mean ± SE: 120.4 ± 2.7 sec) (p = 0.04); however, the effect did not vary by randomization. Conclusion No difference was observed in resuscitation skill retention between the early, late, and no booster groups. More research is needed to determine the aspects of a booster session beyond timing that contribute to skill retention.
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Affiliation(s)
- Richard Waldolf
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Department of Innovation and Medical Education, University of Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ontario, Canada
| | | | - Dylan Bould
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ontario, Canada
| | - Chilombo Bould
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ontario, Canada
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ontario, Canada
| | - Cole Etherington
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
| | - Graeme McBride
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Sylvain Boet
- Department of Innovation and Medical Education, University of Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
- Faculty of Education, University of Ottawa, Ontario, Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ontario, Canada
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12
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Kadish CB, Lloyd JK, Adelgais KM, Ward CE, Lo CB, Truelove A, Leonard JC. Prehospital Recognition and Management of Pediatric Sepsis: A Qualitative Assessment. PREHOSP EMERG CARE 2023; 27:775-785. [PMID: 37141419 DOI: 10.1080/10903127.2023.2210217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND PURPOSE Sepsis is a life-threatening disease in children and is a leading cause of morbidity and mortality. Early prehospital recognition and management of children with sepsis may have significant effects on the timely resuscitation of this high-risk clinical condition. However, the care of acutely ill and injured children in the prehospital setting can be challenging. This study aims to understand barriers, facilitators, and attitudes regarding recognition and management of pediatric sepsis in the prehospital setting. METHODS This was a qualitative study of EMS professionals participating in focus groups using a grounded theory-based design to gather information on recognition and management of septic children in the prehospital setting. Focus groups were held for EMS administrators and medical directors. Separate focus groups were held for field clinicians. Focus groups were conducted via video conference until saturation of ideas was reached. Using consensus methodology, transcripts were coded in an iterative process. Data were then organized into positive and negative factors based on the validated PRECEDE-PROCEED model for behavioral change. RESULTS Thirty-eight participants in six focus groups identified nine environmental factors, 21 negative factors, and 14 positive factors pertaining to recognition and management of pediatric sepsis. These findings were organized into the PRECEDE-PROCEED planning model. Pediatric sepsis guidelines were identified as positive factors when they did exist and negative factors when they were complicated or did not exist. Six interventions were identified by participants. These include raising awareness of pediatric sepsis, increasing pediatric education, receiving feedback on prehospital encounters, increasing pediatric exposure and skills training, and improving dispatch information. CONCLUSION This study fills a gap by examining barriers and facilitators to prehospital diagnosis and management of pediatric sepsis. Using the PRECEDE-PROCEED model, nine environmental factors, 21 negative factors, and 14 positive factors were identified. Participants identified six interventions that could create the foundation to improve prehospital pediatric sepsis care. Policy changes were suggested by the research team based on the results of this study. These interventions and policy changes provide a roadmap for improving care in this population and lay the groundwork for future research.
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Affiliation(s)
- Chelsea B Kadish
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Julia K Lloyd
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kathleen M Adelgais
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Caleb E Ward
- Children's National Hospital, George Washington University, Washington, District of Columbia
| | - Charmaine B Lo
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Annie Truelove
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Julie C Leonard
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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13
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Watson J, Cumming O, Dreibelbis R. Nongovernmental Organization Practitioners' Perspectives on the Challenges and Solutions to Changing Handwashing Behavior in Older Children: A Qualitative Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00231. [PMID: 36853630 PMCID: PMC9972390 DOI: 10.9745/ghsp-d-22-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increasing handwashing with soap (HWWS) among older children (aged 5-14 years) can achieve a substantial public health impact. However, HWWS interventions targeting older children have had mixed success. Recent research has attempted to quantitatively identify effective intervention techniques; however, success is likely also influenced by the wider context of implementation. We explore nongovernmental organization (NGO) practitioners' perspectives on the challenges and solutions to HWWS interventions targeting older children to enhance understanding of what is required, beyond intervention content, for them to be effective. METHODS We conducted in-depth, semistructured interviews in April-November 2020 with 25 practitioners employed across 11 NGOs and involved in HWWS interventions targeting older children in development and humanitarian settings. We used purposive and snowball sampling to recruit participants in roles at the global, national/regional, and local levels. Interviews were audio-recorded, transcribed, and thematically analyzed to identify challenges and solutions to HWWS interventions targeting older children. Results were organized according to program development cycle stages. RESULTS Twelve themes relating to perceived challenges emerged: (1) lack of prioritization, (2) funding inconsistency, (3) insufficient formative research, (4) demand on resources, (5) unengaging intervention content, (6) non-enabling physical environments, (7) availability of skilled implementers, (8) reaching out-of-school children, (9) community mistrust, (10) lack of coordination, (11) lack of evaluation rigor, and (12) failure to assign older children's HWWS as a primary outcome in evaluations of hygiene interventions. Recommended solutions were at the intervention, organization, and sector levels. CONCLUSION Intervention design and delivery are important for the success of HWWS interventions for older children, but contextual factors, such as the availability of human and material resources and the level of coordination within and beyond the NGO sector, should also be considered. NGOs need to prioritize HWWS promotion among older children and support programs accordingly.
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Affiliation(s)
- Julie Watson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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O'Leary A, Butler P, Fine JR. Dedicated chest compressor team: A quality improvement initiative to improve chest compression performance at in-hospital cardiac arrest events through quarterly training. Resusc Plus 2023; 13:100361. [PMID: 36798488 PMCID: PMC9926014 DOI: 10.1016/j.resplu.2023.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background High-quality cardiopulmonary resuscitation (CPR) is foundational to all resuscitative efforts. Spaced practice improves learners' skill retention. We evaluated the implementation of a quarterly CPR curriculum and skills training program for a dedicated chest compressor team to improve the quality of CPR performed during in-hospital cardiac arrest (IHCA) events and its impact on patient survival of event. Methods Baseline observations on CPR performance within the hospital were collected in October 2018. The CPR quarterly training program was implemented in November 2018. Training included use of high-fidelity simulation manikins and team members received real-time feedback scores related to compression rate, depth and recoil. High-quality CPR scores were set at ≥ 70%. Yearly IHCA event survival data was examined in relation to the implementation of training. Results Quarterly CPR training of the team led to retention of CPR skills (chest compression rate, depth, and recoil). The team's initial CPR training performance average score was 49.1%, increasing to 80.3%, with 95% (n = 37) of participants achieving a higher score after feedback during their initial training. A two-sample t-test was used for numerical data and chi-square was used for proportional data analysis. The survival of event prior to this training was 61.0% January-October 2018. Post -training, event survival rose to 73.5% (p-value 0.03) in 2019. Conclusion Implementation of a team that attends quarterly CPR training with a high-fidelity simulation manikin is attainable. This training resulted in improved CPR quality and benefited IHCA event survival.
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Affiliation(s)
- Amanda O'Leary
- University of California Davis Medical Center, Patient Care Resources, 2335 Stockton Blvd, Suite 3011, Sacramento, CA 95817, United States,Corresponding author.
| | - Polly Butler
- University of California Davis Medical Center, Center for Professional Practice of Nursing, 4900 Broadway Suite 1630, Sacramento, CA 95820, United States
| | - Jeffrey R. Fine
- University of California Davis, Department of Public Health Sciences, 2921 Stockton Blvd Suite 1400, Sacramento, CA 95817, United States
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15
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Saidu A, Lee K, Ismail I, Arulogun O, Lim PY. Effectiveness of video self-instruction training on cardiopulmonary resuscitation retention of knowledge and skills among nurses in north-western Nigeria. Front Public Health 2023; 11:1124270. [PMID: 37026136 PMCID: PMC10070802 DOI: 10.3389/fpubh.2023.1124270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/20/2023] [Indexed: 04/08/2023] Open
Abstract
Background Adaptable cardiopulmonary resuscitation/basic life support (CPR/BLS) training are required to reduce cardiac arrest mortality globally, especially among nurses. Thus, this study aims to compared CPR knowledge and skills retention level between instructor-led (control group) and video self-instruction training (intervention group) among nurses in northwestern Nigeria. Methods A two-arm randomized controlled trial study using double blinding method was conducted with 150 nurses from two referral hospitals. Stratified simple random method was used to choose eligible nurses. For video self-instruction training (intervention group), participants learnt the CPR training via computer in a simulation lab for 7 days, in their own available time whereas for instructor-led training (control group), a 1-day program was conducted by AHA certified instructors. A generalized estimated equation model was used for statistical analysis. Results Generalized Estimated Equation showed that there were no significant differences between the intervention group (p = 0.055) and control group (p = 0.121) for both CPR knowledge and skills levels respectively, whereas higher probability of having good knowledge and skills in a post-test, one month and three-month follow-up compared to baseline respectively, adjusted with covariates (p < 0.05). Participants had a lower probability of having good skills at 6-month follow-up compared to baseline, adjusted with covariates (p = 0.003). Conclusion This study showed no significant differences between the two training methods, hence video self-instruction training is suggested can train more nurses in a less cost-effective manner to maximize resource utilization and quality nursing care. It is suggested to be used to improve knowledge and skills among nurses to ensure cardiac arrest patients receive excellent resuscitation care.
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Affiliation(s)
- Ahmed Saidu
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Federal University Birnin-Kebbi, Birnin Kebbi, Kebbi, Nigeria
| | - Khuan Lee
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Iskasymar Ismail
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- RESQ Stroke Emergency Unit, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Malaysia
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- *Correspondence: Poh Ying Lim
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16
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Effect of a hybrid team-based advanced cardiopulmonary life support simulation program for clinical nurses. PLoS One 2022; 17:e0278512. [PMID: 36525410 PMCID: PMC9757587 DOI: 10.1371/journal.pone.0278512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND During in-hospital cardiac arrest events, clinical nurses are often the first responders; therefore, nurses require sufficient advanced cardiac life support (ACLS) competency. This study aimed to verify the effects of a hybrid team-based ACLS simulation (HTAS) program (developed in this study) on nurses' ACLS performance, specifically ACLS knowledge, cardiopulmonary resuscitation (CPR) self-efficacy, and CPR-related stress. METHODS The developed HTAS comprised four lecture videos, one team-based skills training video, and a team-based ACLS simulation. A quasi-experimental pretest-posttest design with a comparison group (CG) was used to evaluate the effectiveness of the HTAS. Of the 226 general ward nurses with more than 6 months of clinical experience, 117 were allocated to the intervention group (IG), which attended the HTAS, and 109 to the CG, which attended only basic ACLS training. RESULTS The IG's ACLS performance significantly improved (t = 50.8, p < 0.001) after the training. Relative to the respective pretest conditions, posttest ACLS knowledge (t = 6.92, p < 0.001) and CPR self-efficacy (t = 6.97, p < 0.001) of the IG also significantly increased. However, when the mean difference values were compared, there was no significant difference between the two groups with respect to ACLS knowledge (t = 1.52, p = 0.130), CPR self-efficacy (t = -0.42, p = 0.673), and CPR stress (t = -0.88, p = 0.378). CONCLUSION The HTAS for ward nurses was effective at enhancing the nurses' ACLS performance. It is necessary to develop effective training methods for team-based ACLS and verify the sustained effects of such training.
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17
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Nalule Y, Pors P, Samol C, Ret S, Leang S, Ir P, Macintyre A, Dreibelbis R. A controlled before-and-after study of a multi-modal intervention to improve hand hygiene during the peri-natal period in Cambodia. Sci Rep 2022; 12:19646. [PMID: 36385113 PMCID: PMC9666993 DOI: 10.1038/s41598-022-23937-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/08/2022] [Indexed: 11/17/2022] Open
Abstract
Adequate hand hygiene practices throughout the continuum of care of maternal and newborn health are essential for infection prevention. However, the hand hygiene compliance of facility-based birth attendants, parents and other caregivers along this continuum is low and behavioural-science informed interventions targeting the range of caregivers in both the healthcare facility and home environments are scarce. We assessed the limited efficacy of a novel multimodal behaviour change intervention, delivered at the facility, to improve the hand hygiene practices among midwives and caregivers during childbirth through the return to the home environment. The 6-month intervention was implemented in 4 of 8 purposively selected facilities and included environmental restructuring, hand hygiene infrastructure provision, cues and reminders, and participatory training. In this controlled before-and-after study, the hand hygiene practices of all caregivers present along the care continuum of 99 women and newborns were directly observed. Direct observations took place during three time periods; labour, delivery and immediate aftercare in the facility delivery room, postnatal care in the facility ward and in the home environment within the first 48 h following discharge. Multilevel logistic regression models, adjusted for baseline measures, assessed differences in hand hygiene practices between intervention and control facilities. The intervention was associated with increased odds of improved practice of birth attendants during birth and newborn care in the delivery room (Adjusted odds ratio [AOR] = 4.7; 95% confidence interval [CI] = 2.7, 7.7), and that of parental and non-parental caregivers prior to newborn care in the post-natal care ward (AOR = 9.2; CI = 1.3, 66.2); however, the absolute magnitude of improvements was limited. Intervention effects were not presented for the home environment due COVID-19 related restrictions on observation duration at endline which resulted in too low observation numbers to warrant testing. Our results suggest the potential of a facility-based multimodal behaviour change intervention to improve hand hygiene practices that are critical to maternal and neonatal infection along the continuum of care.
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Affiliation(s)
- Yolisa Nalule
- grid.8991.90000 0004 0425 469XDisease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | | | | | | | - Supheap Leang
- grid.436334.5National Institute of Public Health, Phnom Penh, Cambodia
| | - Por Ir
- grid.436334.5National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Robert Dreibelbis
- grid.8991.90000 0004 0425 469XDisease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
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18
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Gugelmin-Almeida D, Tobase L, Maconochie I, Polastri T, Rodrigues Gesteira EC, Williams J. What can be learned from the literature about intervals and strategies for paediatric CPR retraining of healthcare professionals? A scoping review of literature. Resusc Plus 2022; 12:100319. [PMCID: PMC9630773 DOI: 10.1016/j.resplu.2022.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Effective training and retraining may be key to good quality paediatric cardiopulmonary resuscitation (pCPR). PCPR skills decay within months after training, making the current retraining intervals ineffective. Establishing an effective retraining strategy is fundamental to improve quality of performance and potentially enhance patient outcomes. Objective To investigate the intervals and strategies of formal paediatric resuscitation retraining provided to healthcare professionals, and the associated outcomes including patient outcomes, quality of performance, retention of knowledge and skills and rescuer’s confidence. Methods This review was drafted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). PubMed, Medline, Cochrane, Embase, CINAHL Complete, ERIC and Web of Science were searched and studies addressing the PICOST question were selected. Results The results indicate complex data due to significant heterogeneity among study findings in relation to study design, retraining strategies, outcome measures and length of intervention. Out of 4706 studies identified, 21 were included with most of them opting for monthly or more frequent retraining sessions. The length of intervention ranged from 2-minutes up to 3.5 hours, with most studies selecting shorter durations (<1h). All studies pointed to the importance of regular retraining sessions for acquisition and retention of pCPR skills. Conclusions Brief and frequent pCPR retraining may result in more successful skill retention and consequent higher-quality performance. There is no strong evidence regarding the ideal retraining schedule however, with as little as two minutes of refresher training every month, there is the potential to increase pCPR performance and retain the skills for longer.
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Key Words
- paediatric cardiopulmonary resuscitation
- training strategies
- retraining intervals
- scoping review
- healthcare professionals
- apls, advanced paediatric life support
- atls, advanced trauma life support
- bls, basic life support
- cpr, cardiopulmonary resuscitation
- em, emergency medical
- ems, emergency medical services
- epals, european paediatric advanced life support
- ilcor, international liaison committee on resuscitation
- pcpr, paediatric cardiopulmonary resuscitation
- pals, paediatric advanced life support
- phpls, pre-hospital paediatric life support
- pils, paediatric intermediate life support
- rct, randomised controlled trial
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Affiliation(s)
- Debora Gugelmin-Almeida
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth BH8 8GP, England,Corresponding author.
| | - Lucia Tobase
- Centro Universitário São Camilo, Rua Raul Pompeia, 144, São Paulo, Brazil
| | - Ian Maconochie
- Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
| | - Thatiane Polastri
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, Brazil
| | | | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth BH8 8GP, England
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19
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Halamek LP, Weiner GM. State-of-the art training in neonatal resuscitation. Semin Perinatol 2022; 46:151628. [PMID: 35717245 DOI: 10.1016/j.semperi.2022.151628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Healthcare training has traditionally emphasized acquisition and recall of vast amounts of content knowledge; however, delivering care during resuscitation of neonates requires much more than content knowledge. As the science of resuscitation has progressed, so have the methodologies and technologies used to train healthcare professionals in the cognitive, technical and behavioral skills necessary for effective resuscitation. Simulation of clinical scenarios, debriefing, virtual reality, augmented reality and audiovisual recordings of resuscitations of human neonates are increasingly being used in an effort to improve human and system performance during this life-saving intervention. In the same manner, as evidence has accumulated to support the guidelines for neonatal resuscitation so, too, has affirmation of training methodologies and technologies. This guarantees that training in neonatal resuscitation will continue to evolve to meet the needs of healthcare professionals charged with caring for newborns at one of the most vulnerable times in their lives.
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Affiliation(s)
- Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Center for Academic Medicine, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | - Gary M Weiner
- Department of Pediatrics, Neonatal-Perinatal Medicine, Director, Neonatal-Perinatal Medicine Fellowship Training Program, University of Michigan, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, Room 8621 (C&W), Ann Arbor, MI 48109-4254, USA
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20
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Stærk M, Lauridsen KG, Støtt CT, Riis DN, Løfgren B, Krogh K. Inhospital cardiac arrest - the crucial first 5 min: a simulation study. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:29. [PMID: 36085089 PMCID: PMC9462625 DOI: 10.1186/s41077-022-00225-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early recognition and call for help, fast initiation of chest compressions, and early defibrillation are key elements to improve survival after cardiac arrest but are often not achieved. We aimed to investigate what occurs during the initial treatment of unannounced in situ simulated inhospital cardiac arrests and reasons for successful or inadequate initial resuscitation efforts. METHODS We conducted unannounced full-scale in situ simulated inhospital cardiac arrest followed by a debriefing. Simulations and debriefings were video recorded for subsequent analysis. We analyzed quantitative data on actions performed and time measurements to key actions from simulations and qualitative data from transcribed debriefings. RESULTS We conducted 36 simulations. Time to diagnosis of cardiac arrest was 37 (27; 55) s. Time to first chest compression from diagnosis of cardiac arrest was 37 (18; 74) s, time to calling the cardiac arrest team was 144 (71; 180) s, and time to first shock was 221 (181; 301) s. We observed participants perform several actions after diagnosing the cardiac arrest and before initiating chest compressions. Domains emerging from the debriefings were teaming and resources. Teaming included the themes communication, role allocation, leadership, and shared knowledge, which all included facilitators and barriers. Resources included the themes knowledge, technical issues, and organizational resources, of which all included barriers, and knowledge also included facilitators. CONCLUSION Using unannounced in situ simulated cardiac arrests, we found that key elements such as chest compressions, calling the cardiac arrest team, and defibrillation were delayed. Perceived barriers to resuscitation performance were leadership and teaming, whereas experience, clear leadership, and recent training were perceived as important facilitators for treatment progress.
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Affiliation(s)
- Mathilde Stærk
- Department of Medicine, Randers Regional Hospital, Randers, Denmark.,Education and Research, Randers Regional Hospital, Randers, Denmark.,Department of Emergency Medicine, Gødstrup Hospital, Herning, Denmark
| | - Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Emergency Department, Randers Regional Hospital, Randers, Denmark.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - Dung Nguyen Riis
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Løfgren
- Department of Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark. .,Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
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21
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Morgan RW, Nadkarni VM, Sutton RM. Point-of-Care Cardiopulmonary Resuscitation Training and Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs-Reply. JAMA 2022; 328:480-481. [PMID: 35916849 DOI: 10.1001/jama.2022.9476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia
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22
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Data S, Mirette D, Cherop M, Bajunirwe F, Kyakwera C, Robinson T, Josephine NN, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, McIntosh H, Cheng A. Peer Learning and Mentorship for Neonatal Management Skills: A Cluster-Randomized Trial. Pediatrics 2022; 150:188489. [PMID: 35794462 DOI: 10.1542/peds.2021-054471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical knowledge and skills acquired during training programs like Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) decay within weeks or months. We assessed the effect of a peer learning intervention paired with mentorship on retention of HBB and ECEB skills, knowledge, and teamwork in 5 districts of Uganda. METHODS We randomized participants from 36 Ugandan health centers to control and intervention arms. Intervention participants received HBB and ECEB training, a 1 day peer learning course, peer practice scenarios for facility-based practice, and mentorship visits at 2 to 3 and 6 to 7 months. Control arm participants received HBB and ECEB training alone. We assessed clinical skills, knowledge, and teamwork immediately before and after HBB/ECEB training and at 12 months. RESULTS Peer learning (intervention) participants demonstrated higher HBB and ECEB skills scores at 12 months compared with control (HBB: intervention, 57.9%, control, 48.5%, P = .007; ECEB: intervention, 61.7%, control, 49.9%, P = .004). Knowledge scores decayed in both arms (intervention after course 91.1%, at 12 months 84%, P = .0001; control after course 90.9%, at 12 months 82.9%, P = .0001). This decay at 12 months was not significantly different (intervention 84%, control 82.9%, P = .24). Teamwork skills were similar in both arms immediately after training and at 12 months (intervention after course 72.9%, control after course 67.2%, P = .02; intervention at 12 months 70.7%, control at 12 months 67.9%, P = .19). CONCLUSIONS A peer learning intervention resulted in improved HBB and ECEB skills retention after 12 months compared with HBB and ECEB training alone.
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Affiliation(s)
- Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dube Mirette
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Moses Cherop
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Traci Robinson
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | | | - Lenard Abesiga
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tamara Namata
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jennifer L Brenner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Margaret Twine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ian Wishart
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Heather McIntosh
- Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adam Cheng
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
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23
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Yang WS, Yen P, Wang YC, Chien YC, Chie WC, Ma MHM, Chiang WC. Objective performance of emergency medical technicians in the use of mechanical cardiopulmonary resuscitation compared with subjective self-evaluation: a cross-sectional, simulation-based study. BMJ Open 2022; 12:e062908. [PMID: 35768109 PMCID: PMC9244722 DOI: 10.1136/bmjopen-2022-062908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the subjective and objective resuscitation performance of emergency medical technicians (EMTs) using mechanical cardiopulmonary resuscitation (MCPR) devices. DESIGN AND SETTING This was a cross-sectional simulation-based study where participants installed the MCPR device on a training manikin. PARTICIPANTS We assessed EMT-Intermediates (EMT-Is) and EMT-Paramedics (EMT-Ps) of the Emergency Medical Services (Ambulance) Division of the Taipei City Fire Department. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the gap between self-perceived (subjective) and actual (objective) no-flow time during resuscitation, which we hypothesised as statistically insignificant. The secondary outcome was the association between resuscitation performance and personal attributes like knowledge, attitude and self-confidence. RESULTS Among 210 participants between 21 and 45 years old, only six were female. There were 144 EMT-Is and 66 EMT-Ps. During a simulated resuscitation lasting between four and a half and 5 min, EMTs had longer actual no-flow time compared with self-perceived no-flow time (subjective, 38 s; objective, 57.5 s; p value<0.001). This discrepancy could cause a 6.5% drop of the chest compression fraction in a resuscitation period of 5 min. Among the EMT personal factors, self-confidence was negatively associated with objective MCPR deployment performance (adjusted OR (aOR) 0.66, 95% CI 0.45 to 0.97, p=0.033) and objective teamwork performance (aOR 0.57, 95% CI 0.34 to 0.97, p=0.037) for EMT-Ps, whereas knowledge was positively associated with objective MCPR deployment performance (aOR 2.15, 95% CI 1.31 to 3.52, p=0.002) and objective teamwork performance (aOR 1.77, 95% CI 1.02 to 3.08, p=0.043) for EMT-Is. Moreover, regarding the self-evaluation of no-flow time, both self-satisfaction and self-abasement were associated with objectively poor teamwork performance. CONCLUSIONS EMTs' subjective and objective performance was inconsistent during the MCPR simulation. Self-confidence and knowledge were personal factors associated with MCPR deployment and teamwork performance. Both self-satisfaction and self-abasement were detrimental to teamwork during resuscitation.
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Affiliation(s)
- Wen-Shuo Yang
- Emergency Medical Services (Ambulance) Division, Taipei City Fire Department, Taipei City, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Ping Yen
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - Yao-Cheng Wang
- Fourth District Headquarters, Taipei City Fire Department, Taipei City, Taiwan
| | - Yu-Chun Chien
- Emergency Medical Services Division, National Fire Agency, Ministry of the Interior, New Taipei City, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu City, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu City, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
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24
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Khan UR, Khudadad U, Baig N, Ahmed F, Raheem A, Hisam B, Khan NU, Hock MOE, Razzak JA. Out of hospital cardiac arrest: experience of a bystander CPR training program in Karachi, Pakistan. BMC Emerg Med 2022; 22:93. [PMID: 35659187 PMCID: PMC9164717 DOI: 10.1186/s12873-022-00652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nearly 90% of out-of-hospital cardiac arrest (OHCA) patients are witnessed, yet only 2.3% received bystander cardiopulmonary resuscitation (CPR) in Pakistan. This study aimed to determine retention of knowledge and skills of Hands-Only CPR among community participants in early recognition of OHCA and initiation of CPR in Karachi, Pakistan.
Methods
Pre and post-tests were conducted among CPR training participants from diverse non-health-related backgrounds from July 2018 to October 2019. Participants were tested for knowledge and skills of CPR before training (pre-test), immediately after training (post-test), and 6 months after training (re-test). All the participants received CPR training through video and scenario-based demonstration using manikins. Post-training CPR skills of the participants were assessed using a pre-defined performance checklist. The facilitator read out numerous case scenarios to the participants, such as drowning, poisoning, and road traffic injuries, etc., and then asked them to perform the critical steps of CPR identified in the scenario on manikins. The primary outcome was the mean difference in the knowledge score and skills of the participants related to the recognition of OHCA and initiation of CPR.
Results
The pre and post-tests were completed by 652 participants, whereas the retention test after 6 months was completed by 322 participants. The mean knowledge score related to the recognition of OHCA, and initiation of CPR improved significantly (p < 0.001) from pre-test [47.8/100, Standard Deviation (SD) ±13.4] to post-test (70.2/100, SD ±12.1). Mean CPR knowledge after 6 months (retention) reduced slightly from (70.2/100, ±12.1) to (66.5/100, ±10.8). CPR skill retention for various components (check for scene safety, check for response, check for breathing and correct placement of the heel of hands) deteriorated significantly (p < 0.001) from 77.9% in the post-test to 72.8% in re-test. Participants performed slightly better on achieving an adequate rate of chest compressions from 73.1% in post-test to 76.7% in re-test (p 0.27).
Conclusion
Community members with non-health backgrounds can learn and retain CPR skills, allowing them to be effective bystander CPR providers in OHCA situations. We recommend mass population training in Pakistan for CPR to increase survival from OHCA.
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25
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Kowalski C, Boulesteix AL, Harendza S. Effective methods to enhance medical students' cardioversion and transcutaneous cardiac pacing skills retention - a prospective controlled study. BMC MEDICAL EDUCATION 2022; 22:417. [PMID: 35650577 PMCID: PMC9158220 DOI: 10.1186/s12909-022-03495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Guideline-based therapy of cardiac arrhythmias is important for many physicians from the beginning of their training. Practical training of the required skills to treat cardiac arrhythmias is useful for acquiring these skills but does not seem sufficient for skill retention. The aim of this study was to compare different retention methods for skills required to treat cardiac arrhythmias with respect to the performance of these skills in an assessment. METHODS Seventy-one final-year medical students participated in a newly designed workshop to train synchronized cardioversion (SC) and transcutaneous cardiac pacing (TCP) skills in 2020. All participants completed an objective structured clinical examination (OSCE 1) one week after the training. Afterwards, the participants were stratified and randomized into three groups. Nine weeks later, one group received a standard operating procedure (SOP) for the skills, one group participated in a second workshop (SW), and one group received no further intervention (control). Ten weeks after the first training, all groups participated in OSCE 2. RESULTS The average score of all students in OSCE 1 was 15.6 ± 0.8 points with no significant differences between the three groups. Students in the control group reached a significantly (p < 0.001) lower score in OSCE 2 (-2.0 points, CI: [-2.9;-1.1]) than in OSCE 1. Students in the SOP-group achieved on average the same result in OSCE 2 as in OSCE 1 (0 points, CI: [-0.63;+0.63]). Students who completed a second skills training (SW-group) scored not significantly higher in OSCE 2 compared to OSCE 1 (+0.4 points, CI: [-0.29;+1.12]). The OSCE 2 scores in groups SOP and SW were neither significantly different nor statistically equivalent. CONCLUSIONS Partial loss of SC and TCP skills acquired in a workshop can be prevented after 10 weeks by reading an SOP as well as by a second workshop one week before the second assessment. Refreshing practical skills with an SOP could provide an effective and inexpensive method for skills retention compared to repeating a training. Further studies need to show whether this effect also exists for other skills and how frequently an SOP should be re-read for appropriate long-term retention of complex skills.
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Affiliation(s)
- Christian Kowalski
- Department of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany
| | - Anne-Laure Boulesteix
- Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical, Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Lauridsen KG, Løfgren B, Brogaard L, Paltved C, Hvidman L, Krogh K. Cardiopulmonary Resuscitation Training for Healthcare Professionals: A Scoping Review. Simul Healthc 2022; 17:170-182. [PMID: 34652328 DOI: 10.1097/sih.0000000000000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT The optimal strategy for training cardiopulmonary resuscitation (CPR) for healthcare professionals remains to be determined. This scoping review aimed to describe the emerging evidence for CPR training for healthcare professionals.We screened 7605 abstracts and included 110 studies in this scoping review on CPR training for healthcare professionals. We assessed the included articles for evidence for the following topics: training duration, retraining intervals, e-learning, virtual reality/augmented reality/gamified learning, instructor-learner ratio, equipment and manikins, other aspects of contextual learning content, feedback devices, and feedback/debriefing. We found emerging evidence supporting the use of low-dose, high-frequency training with e-learning to achieve knowledge, feedback devices to perform high-quality chest compressions, and in situ team simulations with debriefings to improve the performance of provider teams.
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Affiliation(s)
- Kasper Glerup Lauridsen
- From the Department of Medicine (K.G.L., B.L.), Randers Regional Hospital, Randers; Research Center for Emergency Medicine (K.G.L., B.L., K.K.), Aarhus University Hospital, Aarhus, Denmark; Center for Simulation, Innovation, and Advanced Education (K.G.L.), Children's Hospital of Philadelphia, Philadelphia; Department of Clinical Medicine (B.L.), Aarhus University; Department of Obstetrics and Gynaecology (L.B., L.H.), Aarhus University Hospital; Corporate HR Midtsim (C.P.) Central Denmark Region; and Department of Anesthesiology, Aarhus University Hospital (K.K.), Aarhus University Hospital, Aarhus, Denmark
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27
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Boet S, Waldolf R, Bould C, Lam S, Burns JK, Moffett S, McBride G, Ramsay T, Bould MD. Early or late booster for basic life support skill for laypeople: a simulation-based randomized controlled trial. CAN J EMERG MED 2022; 24:408-418. [PMID: 35438450 DOI: 10.1007/s43678-022-00291-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Retention of skills and knowledge has been shown to be poor after resuscitation training. The effect of a "booster" is controversial and may depend on its timing. We compared the effectiveness of an early versus late booster session after Basic Life Support (BLS) training for skill retention at 4 months. METHODS We performed a single-blind randomized controlled trial in a simulation environment. Eligible participants were adult laypeople with no BLS training or practice in the 6 months prior to the study. We provided participants with formal BLS training followed by an immediate BLS skills post-test. We then randomized participants to one of three groups: control, early booster, or late booster. Based on their group allocation, participants attended a brief BLS refresher at either 3 weeks after training (early booster), at 2 months after training (late booster), or not at all (control). All participants underwent a BLS skills retention test at 4 months. We measured BLS skill performance according to the Heart and Stroke Foundation's skills testing checklist for adult CPR and the use of an automated external defibrillator. RESULTS A total of 80 laypeople were included in the analysis (control group, n = 28; early booster group, n = 23; late booster group, n = 29). The late booster group achieved better skill retention (mean difference in checklist score at retention compared to the immediate post-test = - 0.8 points out of 15, [95% CI - 1.7, 0.2], P = 0.10) compared to the early booster (- 1.3, [- 2.6, 0.0], P = 0.046) and control group (- 3.2, [- 4.7, - 1.8], P < 0.001). CONCLUSION A late booster session improves BLS skill retention at 4 months in laypeople. TRIAL REGISTRATION NUMBER NCT02998723.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M2, Canada.
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Institut du Savoir Montfort, Ottawa, ON, Canada.
- Faculty of Medicine, Francophone Affairs, University of Ottawa, Ottawa, ON, Canada.
- Faculty of Education, University of Ottawa, Ottawa, ON, Canada.
| | - Richard Waldolf
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Chilombo Bould
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M2, Canada
| | - Sandy Lam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Joseph K Burns
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stéphane Moffett
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M2, Canada
| | - Graeme McBride
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M2, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Dylan Bould
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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Herrera-Aliaga E, Estrada LD. Trends and Innovations of Simulation for Twenty First Century Medical Education. Front Public Health 2022; 10:619769. [PMID: 35309206 PMCID: PMC8929194 DOI: 10.3389/fpubh.2022.619769] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.
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Affiliation(s)
| | - Lisbell D. Estrada
- Faculty of Health Sciences, Universidad Bernardo O'Higgins, Santiago, Chile
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29
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Oermann MH, Krusmark MA, Kardong-Edgren S, Jastrzembski TS, Gluck KA. Personalized Training Schedules for Retention and Sustainment of Cardiopulmonary Resuscitation Skills. Simul Healthc 2022; 17:e59-e67. [PMID: 34009911 PMCID: PMC8812420 DOI: 10.1097/sih.0000000000000559] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The study examined how the spacing of training during initial acquisition of cardiopulmonary resuscitation (CPR) skill affects longer-term retention and sustainment of these skills. METHODS This was a multiphased, longitudinal study. Nursing students were randomly assigned to 2 initial acquisition conditions in which they completed 4 consecutive CPR training sessions spaced by shorter (1 or 7 days) or longer (30 or 90 days) training intervals. Students were additionally randomized to refresh skills for 1 year every 3 months, 6 months, or at a personalized interval prescribed by the Predictive Performance Optimizer (PPO), a cognitive tool that predicts learning and decay over time. RESULTS At the end of the acquisition period, performance was better if training intervals were shorter. At 3 or 6 months after acquisition, performance was better if initial training intervals were longer. At 1 year after acquisition, compression and ventilation scores did not differ by initial training interval nor by 3-month or PPO-prescribed sustainment interval refreshers. However, 6-month interval refreshers were worse than the PPO for compressions and worse than 3 months for ventilations. At the final test session, participants in the personalized PPO condition had less variability in compression scores than either the 3- or 6-month groups. CONCLUSIONS Results suggest that CPR learning trajectories may be accelerated by first spacing training sessions by days and then expanding to longer intervals. Personalized scheduling may improve performance, minimize performance variability, and reduce overall training time.
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30
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Struwe LA, Rhone KB, Haas D, Cohen MZ. Comparison of Recertification Methods on CPR Quality. J Contin Educ Nurs 2022; 53:43-48. [PMID: 34978475 DOI: 10.3928/00220124-20211210-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND High-quality cardiopulmonary resuscitation (CPR) is vital to improving survival from cardiac arrest. This study compared participant performance of CPR with three American Heart Association (AHA)-approved CPR recertification programs because current literature does not show which method is superior. Our goal is to investigate the best training methods to deliver high-quality CPR. METHOD Participants were within 90 days of recertification in face-to-face, Heart Code, or Resuscitation Quality Improvement (RQI). RESULTS No statistically significant differences were found among training modalities or demographic characteristics. The only significant difference was among those who had performed CPR on a human. CONCLUSION Mean scores for the three modalities did not reach the passing requirement for AHA, suggesting that one method of CPR training is not better than the others. Recommendations for translating these findings into clinical practice include mock codes with the ability to measure CPR metrics and simulations of cardiac responses to provide vicarious CPR experience. [J Contin Educ Nurs. 2022;53(1):43-48.].
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A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer. Eur J Pediatr 2022; 181:4101-4109. [PMID: 36114832 PMCID: PMC9483516 DOI: 10.1007/s00431-022-04625-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022]
Abstract
Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each 'FAIL' during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly 'PASSES' were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann-Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9-10 months; of those achieving competence at month 2, 86% demonstrated competence at 8-9 months; of those participants achieving competence at month 3, 67% retained competence at 7-8 months; for those achieving competence at month 4, 80% demonstrated retention at 6-7 months. Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence. What is Known: • Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training. • Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established. What is New: • Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months. • With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up.
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Lauridsen KG, Højbjerg R, Schmidt AS, Løfgren B. Why Do Not Physicians Attend Hospital Cardiopulmonary Resuscitation Training? Open Access Emerg Med 2021; 13:543-551. [PMID: 34938128 PMCID: PMC8685550 DOI: 10.2147/oaem.s332739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Cardiopulmonary resuscitation (CPR) training is mandatory in most hospitals. Despite this, some hospital staff do not attend CPR training on a regular basis, but the barriers to training attendance are sparsely investigated. This study aimed to investigate CPR course attendance, barriers to participation, and possible initiatives to increase CPR course attendance. Methods Physicians from one university hospital and one regional hospital in the Central Denmark Region were included. Questionnaires were handed out at daily staff meetings at departments of internal medicine and surgery. Results In total, 233 physicians responded (response rate: 92%, male: 54%). Overall, 32% of physicians had not attended CPR training at the hospital. Mean (±standard deviation) time since the last CPR course participation was 17 (±3) months. Frequent barriers to attending courses included not knowing when courses are conducted (70%) and where to sign up for training (45%). The majority (60%) of physicians responded that the reason why they prioritize course participation is to be professionally updated. In contrast, 16% stated that they had sufficient CPR skills and therefore CPR training was unnecessary. Physicians stated that the following factors would improve CPR training participation: an annual day protected (no clinical work) for course attendance (72%), use of short booster sessions (49%), shorter courses combined with e-learning (51%) and shorter courses held over 2 days (46%). Conclusion One-third of physicians did not attend hospital CPR training at two Danish hospitals. Several barriers to course participation exist, of which course registration seems to be a crucial factor. Alternative CPR training methods may help improve training participation.
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Affiliation(s)
- Kasper G Lauridsen
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Emergency Department, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Højbjerg
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Anders S Schmidt
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Bettinger K, Mafuta E, Mackay A, Bose C, Myklebust H, Haug I, Ishoso D, Patterson J. Improving Newborn Resuscitation by Making Every Birth a Learning Event. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121194. [PMID: 34943390 PMCID: PMC8700033 DOI: 10.3390/children8121194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is vital to preventing neonatal deaths caused by respiratory depression. Standard resuscitation training programs, combined with frequent simulation practice, have not reached their life-saving potential due to ongoing gaps in bedside performance. Complex neonatal resuscitations, such as those involving positive pressure ventilation, are relatively uncommon for any given resuscitation provider, making consistent clinical practice an unrealistic solution for improving performance. This review discusses strategies to allow every birth to act as a learning event within the context of both high- and low-resource settings. We review strategies that involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. We also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. Strategies that make every birth a learning event have the potential to close performance gaps in newborn resuscitation that remain after training and frequent simulation practice, and they should be prioritized for further development and evaluation.
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Affiliation(s)
- Kourtney Bettinger
- Department of Pediatrics, University of Kansas School of Medicine, 3901 Rainbow Blvd, MS 4004, Kansas City, KS 66103, USA
| | - Eric Mafuta
- School of Public Health, University of Kinshasa, Kinshasa 11850, Democratic Republic of the Congo; (E.M.); (D.I.)
| | - Amy Mackay
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| | - Carl Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| | - Helge Myklebust
- Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, N-4002 Stavanger, Norway; (H.M.); (I.H.)
| | - Ingunn Haug
- Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, N-4002 Stavanger, Norway; (H.M.); (I.H.)
| | - Daniel Ishoso
- School of Public Health, University of Kinshasa, Kinshasa 11850, Democratic Republic of the Congo; (E.M.); (D.I.)
| | - Jackie Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
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Stewart C, Shoemaker J, Keller-Smith R, Edmunds K, Davis A, Tegtmeyer K. Code Team Training: Demonstrating Adherence to AHA Guidelines During Pediatric Code Blue Activations. Pediatr Emerg Care 2021; 37:e1658-e1662. [PMID: 29040245 DOI: 10.1097/pec.0000000000001307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation. METHODS Multidisciplinary code team training sessions were held using high-fidelity, in situ simulation. Sessions were held several times per month. Each session was filmed and reviewed for adherence to 5 AHA guidelines: chest compression rate, ventilation rate, chest compression fraction, use of a backboard, and use of a team leader. After the first study period, modifications were made to the code team including implementation of just-in-time training and alteration of the compression team. RESULTS Thirty-eight sessions were completed, with 31 eligible for video analysis. During the first study period, 1 session adhered to all AHA guidelines. During the second study period, after alteration of the code team and implementation of just-in-time training, no sessions adhered to all AHA guidelines; however, there was an improvement in percentage of sessions adhering to ventilation rate and chest compression rate and an improvement in median ventilation rate. CONCLUSIONS We present a method for training a large code team drawn from multiple hospital departments and a method of assessing code team performance. Despite subjective improvement in code team positioning, communication, and role completion and some improvement in ventilation rate and chest compression rate, we failed to consistently demonstrate improvement in adherence to all guidelines.
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Affiliation(s)
- Claire Stewart
- From the Division of Critical Care, Nationwide Children's Hospital
| | - Jamie Shoemaker
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center
| | - Rachel Keller-Smith
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center
| | - Katherine Edmunds
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | | | - Ken Tegtmeyer
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Performed at Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Data S, Dubé MM, Bajunirwe F, Kyakwera C, Robinson T, Najjuma JN, Cherop M, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, MacIntosh H, Cheng A. Feasibility of an Interprofessional, Simulation-Based Curriculum to Improve Teamwork Skills, Clinical Skills, and Knowledge of Undergraduate Medical and Nursing Students in Uganda: A Cohort Study. Simul Healthc 2021; 16:e100-e108. [PMID: 33337727 DOI: 10.1097/sih.0000000000000531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Many deaths in Sub-Saharan Africa are preventable with provision of skilled healthcare. Unfortunately, skills decay after training. We determined the feasibility of implementing an interprofessional (IP) simulation-based educational curriculum in Uganda and evaluated the possible impact of this curriculum on teamwork, clinical skills (CSs), and knowledge among undergraduate medical and nursing students. METHODS We conducted a prospective cohort study over 10 months. Students were divided into 4 cohorts based on clinical rotations and exposed to rotation-specific simulation scenarios at baseline, 1 month, and 10 months. We measured clinical teamwork scores (CTSs) at baseline and 10 months; CSs at baseline and 10 months, and knowledge scores (KSs) at baseline, 1 month, and 10 months. We used paired t tests to compare mean CTSs and KSs, as well as Wilcoxon rank sum test to compare group CS scores. RESULTS One hundred five students (21 teams) participated in standardized simulation scenarios. We successfully implemented the IP, simulation-based curriculum. Teamwork skills improved from baseline to 10 months when participants were exposed to: (a) similar scenario to baseline {baseline mean CTS = 55.9% [standard deviation (SD) = 14.4]; 10-month mean CTS = 88.6%; SD = 8.5, P = 0.001}, and (b) a different scenario to baseline [baseline mean CTS = 55.9% (SD = 14.4); 10-month CTS = 77.8% (SD = 20.1), P = 0.01]. All scenario-specific CS scores showed no improvement at 10 months compared with baseline. Knowledge was retained in all scenarios at 10 months. CONCLUSIONS An IP, simulation-based undergraduate curriculum is feasible to implement in a low-resource setting and may contribute to gains in knowledge and teamwork skills.
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Affiliation(s)
- Santorino Data
- From the Mbarara University of Science and Technology (S.D., F.B., C.K., N.N.J., C.M., L.A., T.N., M.T.), Mbarara, Uganda; KidSIM Simulation Program (M.D., T.R., I.W., A.C.), Alberta Children's Hospital; and Department of Pediatrics (J.L.B., N.S., I.W., A.C.), and Global Health and International Partnerships (H.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Spies LA, Riley C, Nair R, Hussain N, Reddy MP. High-Frequency, Low-Dose Education to Improve Neonatal Outcomes in Low-Resource Settings: A Cluster Randomized Controlled Trial. Adv Neonatal Care 2021; 22:362-369. [PMID: 34743112 DOI: 10.1097/anc.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Annually 2.5 million infants die in the first 28 days of life, with a significant regional distribution disparity. An estimated 80% of those could be saved if neonatal resuscitation were correctly and promptly initiated. A barrier to achieving the target is the knowledge and skills of healthcare workers. PURPOSE The objective of this cluster randomized trial was to assess the improvement and retention of resuscitation skills of nurses, midwives, and birth attendants in 2 birth centers serving 60 villages in rural India using high-frequency, low-dose training. RESULTS There was a significant difference (P < .05) between the groups in the rate of resuscitation, with 18% needing resuscitation in the control group and 6% in the intervention group. The posttest scores for knowledge retention at the final 8-month evaluation were significantly better in the intervention group than in the control group (intervention group mean rank 19.4 vs control group mean rank 10.3; P < .05). The success rate of resuscitation was not significantly different among the groups. IMPLICATIONS FOR PRACTICE Improved knowledge retention at 8 months and the lower need for resuscitation in the intervention group support the efficacy of the high-frequency, low-dose education model of teaching in this setting. IMPLICATIONS FOR RESEARCH Replication of these findings in other settings with a larger population cohort is needed to study the impact of such intervention on birth outcomes in low-resource settings.
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Frazier ME, Brown SR, O'Halloran A, Raymond T, Hanna R, Niles DE, Kleinman M, Sutton RM, Roberts J, Tegtmeyer K, Wolfe HA, Nadkarni V, Dewan M. Risk factors and outcomes for recurrent paediatric in-hospital cardiac arrest: Retrospective multicenter cohort study. Resuscitation 2021; 169:60-66. [PMID: 34673152 DOI: 10.1016/j.resuscitation.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/09/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
AIM OF STUDY Recurrent in-hospital cardiac arrest (IHCA) is associated with morbidity and mortality in adults. We aimed to describe the risk factors and outcomes for paediatric recurrent IHCA. METHODS Retrospective cohort study of patients ≤18 years old with single or recurrent IHCA. Recurrent IHCA was defined as ≥2 IHCA within the same hospitalization. Categorical variables expressed as percentages and compared via Chi square test. Continuous variables expressed as medians with interquartile ranges and compared via rank sum test. Outcomes assessed in a propensity match cohort. RESULTS From July 1, 2015 to January 26, 2021, 139/894 (15.5%) patients experienced recurrent IHCA. Compared to patients with a single IHCA, recurrent IHCA patients were more likely to be trauma and less likely to be surgical cardiac patients. Median duration of cardiopulmonary resuscitation (CPR) was shorter in the recurrent IHCA (5 vs. 11 min; p < 0.001) with no difference in IHCA location or immediate cause of CPR. Patients with recurrent IHCA had worse survival to intensive care unit (ICU) discharge (31% vs. 52%; p < 0.001), and worse survival to hospital discharge (30% vs. 48%; p < 0.001) in unadjusted analyses and after propensity matching, patients with recurrent IHCA still had worse survival to ICU (34% vs. 67%; p < 0.001) and hospital (31% vs. 64%; p < 0.001) discharge. CONCLUSION When examining those with a single vs. a recurrent IHCA, event and patient factors including more pre-existing conditions and shorter duration of CPR were associated with risk for recurrent IHCA. Recurrent IHCA is associated with worse survival outcomes following propensity matching.
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Affiliation(s)
| | - Stephanie R Brown
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA; Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Amanda O'Halloran
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Tia Raymond
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Richard Hanna
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Dana E Niles
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Monica Kleinman
- Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Robert M Sutton
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Joan Roberts
- Ospedale Pediatrico Bambino Gesù, Rome, Italy; Alberta Children's Hospital, Calgary, AB, Canada
| | - Ken Tegtmeyer
- Riley Hospital for Children, Indianapolis, IN, USA; Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Heather A Wolfe
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Vinay Nadkarni
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Maya Dewan
- Riley Hospital for Children, Indianapolis, IN, USA; Children's Hospital at Westmead, Sydney, NSW, Australia; Stollery Children's Hospital, Edmonton, AB, Canada
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Brogaard L, Glerup Lauridsen K, Løfgren B, Krogh K, Paltved C, Boie S, Hvidman L. The effects of obstetric emergency team training on patient outcome: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 101:25-36. [PMID: 34622945 DOI: 10.1111/aogs.14263] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about the optimal simulation-based team training in obstetric emergencies. We aimed to review how simulation-based team training affects patient outcomes in obstetric emergencies. MATERIAL AND METHODS Search Strategy: MEDLINE, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were searched up to and including May 15, 2021. SELECTION CRITERIA randomized controlled trials (RCTs) and cohort studies on obstetric teams in high-resource settings comparing the effect of simulation-based obstetric emergency team training with no training on the risk of Apgar scores less than 7 at 5 min, neonatal hypoxic ischemic encephalopathy, severe postpartum hemorrhage, blood transfusion of four or more units, and delay of emergency cesarean section by more than 30 min. DATA COLLECTION AND ANALYSIS The included studies were assessed using PRISMA, EPCO, and GRADE. RESULTS We found 21 studies, four RCTs and 17 cohort studies, evaluating patient outcomes after obstetric team training compared with no training. Annual obstetric emergency team training may reduce brachial plexus injury (six cohort studies: odds ratio [OR] 0.47, 95% CI 0.33-0.68; one RCT: OR 1.30, 95 CI% 0.39-4.33, low certainty evidence) and suggest a positive effect; but it was not significant on Apgar score below 7 at 5 min (three cohort studies: OR 0.77, 95% CI 0.51-1.19; two RCT: OR 0.87, 95% CI 0.72-1.05, moderate certainty evidence). The effect was unclear for hypoxic ischemic encephalopathy, umbilical prolapse, decision to birth interval in emergency cesarean section, and for severe postpartum hemorrhage. Studies with in situ multi-professional simulation-based training demonstrated the best effect. CONCLUSIONS Emerging evidence suggests an effect of obstetric team training on obstetric outcomes, but conflicting results call for controlled trials targeted to identify the optimal methodology for effective team training.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Bo Løfgren
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Paltved
- Department of Human Resources, Medical simulation in Central Denmark Region (MidtSim), Aarhus, Denmark
| | - Sidsel Boie
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Teaching hands‐only CPR using behavioral skills training. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Rideout JM, Ozawa ET, Bourgeois DJ, Chipman M, Overly FL. Can hospital adult code-teams and individual members perform high-quality CPR? A multicenter simulation-based study incorporating an educational intervention with CPR feedback. Resusc Plus 2021; 7:100126. [PMID: 34223393 PMCID: PMC8244252 DOI: 10.1016/j.resplu.2021.100126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
Aims A multicenter simulation-based research study to assess the ability of interprofessional code-teams and individual members to perform high-quality CPR (HQ-CPR) at baseline and following an educational intervention with a CPR feedback device. Methods Five centers recruited ten interprofessional teams of AHA-certified adult code-team members with a goal of 200 participants. Baseline testing of chest compression (CC) quality was measured for all individuals. Teams participated in a baseline simulated cardiac arrest (SCA) where CC quality, chest compression fraction (CCF), and peri-shock pauses were recorded. Teams participated in a standardized HQ-CPR and abbreviated TeamSTEPPS® didactic, then engaged in deliberate practice with a CPR feedback device. Individuals were assessed to determine if they could achieve ≥80% combined rate and depth within 2020 AHA guidelines. Teams completed a second SCA and CPR metrics were recorded. Feedback was disabled for assessments except at one site where real-time CPR feedback was the institutional standard. Linear regression models were used to test for site effect and paired t-tests to evaluate significant score changes. Logistic univariate regression models were used to explore characteristics associated with the individual achieving competency. Results Data from 184 individuals and 45 teams were analyzed. Baseline HQ-CPR mean score across all sites was 18.5% for individuals and 13.8% for teams. Post-intervention HQ-CPR mean score was 59.8% for individuals and 37.0% for teams. There was a statistically significant improvement in HQ-CPR mean scores of 41.3% (36.1, 46.5) for individuals and 23.2% (17.1, 29.3) for teams (p < 0.0001). CCF increased at 3 out of 5 sites and there was a mean 5-s reduction in peri-shock pauses (p < 0.0001). Characteristics with a statistically significant association were height (p = 0.01) and number of times performed CPR (p = 0.01). Conclusion Code-teams and individuals struggle to perform HQ-CPR but show improvement after deliberate practice with feedback as part of an educational intervention. Only one site that incorporated real-time CPR feedback devices routinely achieved ≥80% HQ-CPR.
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Affiliation(s)
- Jesse M Rideout
- Department of Emergency Medicine, Tufts Medical Center, United States
| | - Edwin T Ozawa
- Department of Anesthesiology, Lahey Hospital & Medical Center, United States
| | - Darlene J Bourgeois
- Center for Professional Development & Simulation, Lahey Hospital & Medical Center, United States
| | - Micheline Chipman
- Hannaford Center for Safety, Innovation & Simulation, Maine Medical Center, United States
| | - Frank L Overly
- Brown Emergency Medicine and Pediatrics, Hasbro Children's Hospital, United States
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Horiuchi S, Rattana S, Saysanasongkham B, Kounnavongsa O, Kubota S, Inoue M, Yamaoka K. Effectiveness of self-managed continuous monitoring for maintaining high-quality early essential newborn care compared to supervision visit in Lao PDR: a cluster randomised controlled trial. BMC Health Serv Res 2021; 21:460. [PMID: 33985503 PMCID: PMC8120813 DOI: 10.1186/s12913-021-06481-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Thousands of neonatal deaths are expected to be averted by introducing the Early Essential Newborn Care (EENC) in the Western Pacific Region. In Lao People’s Democratic Republic (Lao PDR), the government adopted the EENC programme and expanded it to district hospitals. With the expansion, maintaining the quality of EENC has become difficult for the government. Methods A cluster randomised controlled trial with four strata based on province and history of EENC coaching was implemented to evaluate the effectiveness of self-managed continuous monitoring compared with supervisory visit in Lao PDR between 20 July 2017 and 2 April 2019. Health workers who were routinely involved in maternity care were recruited from 15 district hospitals in Huaphanh (HP) and Xiangkhouang (XK) provinces. The primary endpoint was the score on the determinants of EENC performance measured by the Theory of Planned Behaviour (TPB). Secondary endpoints were set as the knowledge and skill scores. A linear mixed-effects model was applied to test the effects of intervention over time on the endpoints. Results Among 198 recruited health workers, 46 (23.2%) did not complete the final evaluation. TPB scores were 180.9 [Standard Deviation: SD 38.6] and 182.5 [SD 37.7] at baseline and 192.3 [SD 30.1] and 192.3 [SD 28.4] at the final evaluation in the intervention and control groups, respectively. There was no significant difference in changes between the groups in the adjusted model (2.4, p = 0.650). Interviews with participants revealed that district hospitals in HP regularly conducted peer reviews and feedback meetings, while few hospitals did in XK. Accordingly, in stratified analyses, the TPB score in the intervention group significantly increased in HP (15.5, p = 0.017) but largely declined in XK (− 17.7, p = 0.047) compared to the control group after adjusting for covariates. Skill scores declined sharper in the intervention group in XK (− 8.78, p = 0.026), particularly in the practice of managing nonbreathing babies. Conclusions The study indicates that self-managed continuous monitoring is effective in improving behaviour among district health workers; however, additional measures are necessary to support its proper implementation. To maintain resuscitation skills, repeated practice is necessary. Trial registration This trial was registered at UMIN Clinical Trials Registry on 15/6/2017. Registration number is UMIN000027794. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06481-6.
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Affiliation(s)
- Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan.
| | - Sommana Rattana
- Department of Health Care and Rehabilitation, Ministry of Health, Ban thatkhao, Sisattanack District, Rue Simeuang, Vientiane, Lao PDR
| | - Bounnack Saysanasongkham
- Department of Health Care and Rehabilitation, Ministry of Health, Ban Chomcheng, Sisattanack District, Rue Thadeua, Vientiane, Lao PDR
| | - Outhevanh Kounnavongsa
- Reproductive, maternal, newborn, child and adolescent health unit, World Health Organization Representative Office in Lao PDR, Saphanthongtai village, Saphanthong road, Vientiane, Lao PDR
| | - Shogo Kubota
- Reproductive, maternal, newborn, child and adolescent health unit, World Health Organization Representative Office in Lao PDR, Saphanthongtai village, Saphanthong road, Vientiane, Lao PDR
| | - Mariko Inoue
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Kazue Yamaoka
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi, Tokyo, Japan
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Kuyt K, Mullen M, Fullwood C, Chang TP, Fenwick J, Withey V, McIntosh R, Herz N, MacKinnon RJ. The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation quality improvement program in early UK adopter hospitals. Adv Simul (Lond) 2021; 6:14. [PMID: 33883025 PMCID: PMC8058602 DOI: 10.1186/s41077-021-00168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The 'Resuscitation Quality Improvement' (RQI) programme is a quarterly low-dose, high-frequency training, based around the use of manikins connected to a cart providing real-time and summative feedback. We aimed to evaluate the effects of the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted this as a method of BLS training, and establish whether this program leads to increased compliance in CPR training. METHODS The study took place across three adopter sites and one control site. Participants completed a baseline assessment without live feedback. Following this, participants at the adopter sites followed the RQI curriculum for adult CPR, or adult and infant CPR. The curriculum was split into quarterly training blocks, and live feedback was given on technique during the training session via the RQI cart. After following the curriculum for 12/24 months, participants completed a second assessment without live feedback. RESULTS At the adopter sites, there was a significant improvement in the overall score between baseline and assessment for infant ventilations (N = 167, p < 0.001), adult ventilations (n = 129, p < 0.001), infant compressions (n = 163, p < 0.001) adult compressions (n = 205, p < 0.001), and adult CPR (n = 249, p < 0.001). There was no significant improvement in the overall score for infant CPR (n = 206, p = 0.08). Data from the control site demonstrated a statistically significant improvement in mean score for adult CPR (n = 22, p = 0.02), but not for adult compressions (N = 18, p = 0.39) or ventilations (n = 17, p = 0.08). No statistically significant difference in improvement of mean scores was found between the grouped adopter sites and the control site. The effect of the duration of the RQI curriculum on CPR performance appeared to be minimal in this data set. Compliance with the RQI curriculum varied by site, one site maintained hospital compliance at 90% over a 1 year period, however compliance reduced over time at all sites. CONCLUSIONS This data demonstrated an increased adherence with guidelines for high-quality CPR post-training with the RQI cart, for all adult and most infant measures, but not infant CPR. However, the relationship between a formalised quarterly RQI curriculum and improvements in resuscitation skills is not clear. It is also unclear whether the RQI approach is superior to the current classroom-based BLS training for CPR skill acquisition in the UK. Further research is required to establish how to optimally implement the RQI system in the UK and how to optimally improve hospital wide compliance with CPR training to improve the outcomes of in-hospital cardiac arrests.
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Affiliation(s)
- Katherine Kuyt
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Montana Mullen
- Department of Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Catherine Fullwood
- Medical Statistics Group, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Todd P Chang
- Division of Emergency Medicine and Transport, Children's Hospital of Los Angeles, Los Angeles, USA
| | - James Fenwick
- Resuscitation Service, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, UK
| | | | - Rod McIntosh
- Department of Resuscitation, Borders General Hospital, Borders NHS, Selkirk, UK
| | | | - Ralph James MacKinnon
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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Declines in the Number of Lumbar Punctures Performed at United States Children's Hospitals, 2009-2019. J Pediatr 2021; 231:87-93.e1. [PMID: 33080276 DOI: 10.1016/j.jpeds.2020.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/22/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate trends in lumbar puncture (LP) performance among US children's hospitals to assess how these trends may impact pediatric resident trainee exposure to LP. STUDY DESIGN We quantified LPs for emergency department (ED) and inpatient encounters at 29 US children's hospitals from 2009 to 2019. LP was defined by either a LP procedure code or cerebrospinal fluid culture billing code. Temporal trends and hospital variation in LP were assessed using logistic regression analysis. RESULTS A total of 215 030 LPs were performed during the study period (0.8% of all encounters). Twenty six thousand and five hundred twenty three and 16 696 LPs were performed in the 2009 and 2018 academic years, respectively (overall 37.1% reduction, per-year OR, 0.935; 95% CI, 0.922-0.948; P < .001), and the rate of LP decreased from 10.9 per 1000 hospital encounters to 6.0 per 1000 hospital encounters over the same period. CONCLUSIONS LP rates have declined across US children's hospitals over the past decade, potentially resulting in reduced clinical exposure for pediatric resident trainees. Improved procedural simulation during residency may augment the clinical experience.
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Wilson C, Furness E, Proctor L, Sweetman G, Hird K. A randomised trial of the effectiveness of instructor versus automated manikin feedback for training junior doctors in life support skills. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:95-100. [PMID: 33242153 PMCID: PMC7952489 DOI: 10.1007/s40037-020-00631-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/07/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Australian Standards require that clinicians undergo regular training in skills required to respond to the acute deterioration of a patient. Training focuses on the ability to appropriately respond to cardiac arrest, including delivering cardiac compressions, ventilation and appropriate defibrillation. Providing such training comes at a significant cost to the organisation and impacts on clinician time in direct patient care. If effective, the use of an automated manikin could significantly reduce costs and provide consistent training experiences. METHODS Fifty-six resident medical officers were randomised to two groups to test two skills components of hospital life support training under two feedback conditions. The skills components were cardiac compressions and bag-valve-mask ventilation. The feedback conditions were automated feedback delivered by a simulation manikin and traditional feedback delivered by an instructor. All participants were exposed to both skills components and both feedback conditions in a counterbalanced block design. Participants completed surveys before and after training. RESULTS The results demonstrated significantly better performance in cardiac compressions under the automated manikin feedback condition compared with the instructor feedback condition. This difference was not observed in bag-valve-mask ventilation. The majority of participants found the automated manikin feedback more useful than the instructor feedback. DISCUSSION Automated manikin feedback was not inferior to instructor feedback for skill acquisition in cardiac compressions training. The automated feedback condition did not achieve the same level of significance in bag-valve-mask ventilation training. Results suggest training with automated feedback presents a cost-effective opportunity to lessen the training burden, whilst improving skill acquisition.
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Affiliation(s)
- Chris Wilson
- Medical Education Unit, Fiona Stanley Fremantle Hospitals Group, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Erin Furness
- Medical Education Unit, Fiona Stanley Fremantle Hospitals Group, Fiona Stanley Hospital, Murdoch, WA, Australia.
| | - Leah Proctor
- Medical Education Unit, Fiona Stanley Fremantle Hospitals Group, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Greg Sweetman
- Medical Education Unit, Fiona Stanley Fremantle Hospitals Group, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Kathryn Hird
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
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Effect of a positive pressure ventilation-refresher program on ventilation skill performance during simulated newborn resuscitation. Resusc Plus 2021; 5:100091. [PMID: 34223356 PMCID: PMC8244303 DOI: 10.1016/j.resplu.2021.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 11/22/2022] Open
Abstract
Aim Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses. Methods Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10-21 mL) and rate (40-60 ventilations per minute [vpm]). Baseline and post assessments were compared for total number PPV delivered, number target PPV delivered (volume 10-21 mL), mean volume and mean rate (Wilcoxon signed-rank test, median[IQR]). Results Twenty-six subjects were enrolled and completed a baseline assessment; 24 (92%) completed a post-assessment; 2 (8%) were lost to follow-up. Over 3 months, a mean 3.2 (range 1-6) PPV-Refreshers/subject were completed. Compared to baseline, subjects demonstrated significant improvement for total (57 [36-74] vs. 33 [26-46]; p = 0.0007) and target PPV (23 [13-23] vs. 11 [5-21]; p = 0.024), and a significant change in mean volume (mL) (11.5 [10.2-13] vs. 13.4 [11-16]; p = 0.02) and mean rate (vpm) (54 [45-61] vs. 40 [28-49]; p = 0.019). Conclusions A PPV-Refresher program with brief, repeated psychomotor skill practice significantly improved PPV performance with the greatest improvement in total PPV and target PPV. Additional investigation is warranted to determine optimal PPV-Refresher frequency.Registered at ClinicalTrials.gov #NCT02347241.
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Chamdawala H, Meltzer JA, Shankar V, Elachi D, Jarzynka SM, Nixon AF. Cardiopulmonary resuscitation skill training and retention in teens (CPR START): A randomized control trial in high school students. Resusc Plus 2021; 5:100079. [PMID: 34223345 PMCID: PMC8244398 DOI: 10.1016/j.resplu.2021.100079] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/21/2022] Open
Abstract
Aim High school students are currently the largest group of individuals in the US receiving CPR training every year. This study examines the effect of adding a real-time visual feedback device to a standard instructor-led CPR course on skill acquisition and retention in high school students. Methods All study participants underwent baseline CPR skill testing and received a standard instructor-led compression-only CPR course. We then randomized students to a ‘Feedback Group’, consisting of 2 min of CPR training using a real-time visual feedback device, or ‘Standard Group’ that continued to practice on the inflatable manikin. CPR skills for all students were tested afterwards using the feedback device and reported as a compression score (CS) derived from their chest compression depth, rate, hand position, and full chest recoil. We compared the CS at baseline, week-0 (immediately post-intervention), week-10, week-28, and week-52 between groups. Results A total of 220 students were included in the analyses (Feedback Group = 110, Standard Group = 110). Both groups showed similar CPR performance at baseline. At week-0, the Feedback Group had a significantly higher CS compared to the Standard Group (adjusted difference: 20% [95% CI: 11%–29%; p < 0.001]). This difference attenuated over time but remained significant at the week-10 and week-28 follow-up; however, by the week-52 follow-up, there was no significant difference between groups. Conclusions Using a real-time visual feedback device during CPR training significantly improves skill acquisition and retention in high school students and should be integrated into the high school CPR curriculum.
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Affiliation(s)
- Haamid Chamdawala
- Department of Pediatrics, Division of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 6, Room 1B25, Bronx, NY 10461, USA
- Corresponding author at: Department of Pediatrics, NYC Health + Hospitals/Jacobi Medical Center, 1400 Pelham Parkway South, Building 6, Room 1B25, Bronx, NY 10461, USA.
| | - James A. Meltzer
- Department of Pediatrics, Division of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 6, Room 1B25, Bronx, NY 10461, USA
| | - Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block Building, Room 315, Bronx, NY 10461, USA
| | - Dina Elachi
- Department of Pediatrics, Division of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 6, Room 1B25, Bronx, NY 10461, USA
| | - Shannon M. Jarzynka
- Department of Pediatrics, Division of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 6, Room 1B25, Bronx, NY 10461, USA
| | - Abigail F. Nixon
- Department of Pediatrics, Division of Emergency Medicine, NYC Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 6, Room 1B25, Bronx, NY 10461, USA
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Mulholland M, Molloy S, Coulter P, O'Donoghue D, Bourke T, Thompson A. How frequently should paediatric cardiopulmonary resuscitation skills be taught? Arch Dis Child 2020; 106:archdischild-2020-320904. [PMID: 33208394 DOI: 10.1136/archdischild-2020-320904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Seana Molloy
- Royal Belfast Hospital for Sick Children, Belfast, UK
| | | | - Dara O'Donoghue
- Department of Child Health, Centre for Medical Education, Queen's University Belfast, Belfast, UK
- Paediatric Respiratory Medicine, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Thomas Bourke
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
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Lin Y, Hecker K, Cheng A, Grant VJ, Currie G. Cost-effectiveness analysis of workplace-based distributed cardiopulmonary resuscitation training versus conventional annual basic life support training. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:297-303. [DOI: 10.1136/bmjstel-2020-000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 11/04/2022]
Abstract
ContextAlthough distributed cardiopulmonary resuscitation (CPR) practice has been shown to improve learning outcomes, little is known about the cost-effectiveness of this training strategy. This study assesses the cost-effectiveness of workplace-based distributed CPR practice with real-time feedback when compared with conventional annual CPR training.MethodsWe measured educational resource use, costs, and outcomes of both conventional training and distributed training groups in a prospective-randomised trial conducted with paediatric acute care providers over 12 months. Costs were calculated and reported from the perspective of the health institution. Incremental costs and effectiveness of distributed CPR training relative to conventional training were presented. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER) if appropriate. One-way sensitivity analyses and probabilistic sensitivity analysis were conducted.ResultsA total of 87 of 101 enrolled participants completed the training (46/53 in intervention and 41/48 in the control). Compared with conventional training, the distributed CPR training group had a higher proportion of participants achieving CPR excellence, defined as over 90% guideline compliant for chest compression depth, rate and recoil (control: 0.146 (6/41) vs intervention 0.543 (25/46), incremental effectiveness: +0.397) with decreased costs (control: $C266.50 vs intervention $C224.88 per trainee, incremental costs: −$C41.62). The sensitivity analysis showed that when the institution does not pay for the training time, distributed CPR training results in an ICER of $C147.05 per extra excellent CPR provider.ConclusionWorkplace-based distributed CPR training with real-time feedback resulted in improved CPR quality by paediatric healthcare providers and decreased training costs, when training time is paid by the institution. If the institution does not pay for training time, implementing distributed training resulted in better CPR quality and increased costs, compared with conventional training. These findings contribute further evidence to the decision-making processes as to whether institutions/programmes should financially adopt these training programmes.
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Donaldson L, Stevenson MA, Fletcher DJ, Gillespie Í, Kellett-Gregory L, Boller M. Differences in the clinical practice of small animal CPR before and after the release of the RECOVER guidelines: Results from two electronic surveys (2008 and 2017) in the United States and Canada. J Vet Emerg Crit Care (San Antonio) 2020; 30:615-631. [PMID: 32975359 DOI: 10.1111/vec.13010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/24/2019] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether the clinical approach to CPR has changed following the publication of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines in 2012. DESIGN Internet-based survey. SETTING Academia and referral practice. SUBJECTS Four hundred and ninety-one small animal veterinarians in clinical practice in the United States and Canada. INTERVENTIONS An internet-based survey assessing the clinical approach to small animal CPR was circulated with the assistance of veterinary professional organizations on 2 separate occasions: prior to (2008) and following (2017) publication of the 2012 (RECOVER) guidelines. Survey questions identical to both surveys solicited details of clinician approaches to CPR preparedness, basic life support (BLS), and advanced life support (ALS). Respondents were grouped into level of expertise (board-certified specialists [BCS, n = 202] and general practitioners in emergency clinics [GPE, n = 289]), and year of response to the survey (2008, n = 171; 2017, n = 320). MEASUREMENTS AND MAIN RESULTS Compliance with the RECOVER guidelines pertaining to CPR preparedness (P < 0.01), BLS (P < 0.01), and ALS P < 0.01) was consistently higher in respondents to the 2017 survey compared to those of the 2008 survey. Being a BCS was associated with significantly higher compliance with the RECOVER recommendations than GPE in the domains of preparedness (P = 0.02), BLS (P < 0.01), and ALS (P < 0.01). Increases in age of the respondent had a negative effect on compliance with the BLS guidelines (P < 0.01), while gender had no effect. CONCLUSIONS Compared to 2008, current practices in small animal CPR in the North American emergency and critical care community shifted toward those recommended in the RECOVER guidelines across all CPR domains. This supports the notion that uptake of the RECOVER guidelines among veterinary emergency or critical care clinicians was sufficient to lead to a change in the practice of CPR.
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Affiliation(s)
- Liam Donaldson
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - Mark A Stevenson
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - Daniel J Fletcher
- College of Veterinary Medicine, Department of Clinical Sciences, Cornell University, Ithaca, New York
| | - Íde Gillespie
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | | | - Manuel Boller
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia.,Translational Research and Clinical Trials (TRACTs), Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Melbourne, Australia
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Almeida D, Clark C, Jones M, McConnell P, Williams J. Consistency and variability in human performance during simulate infant CPR: a reliability study. Scand J Trauma Resusc Emerg Med 2020; 28:91. [PMID: 32912284 PMCID: PMC7488154 DOI: 10.1186/s13049-020-00785-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/01/2020] [Indexed: 01/26/2023] Open
Abstract
Background Positive outcomes from infant cardiac arrest depend on the effective delivery of resuscitation techniques, including good quality infant cardiopulmonary resuscitation (iCPR) However, it has been established that iCPR skills decay within weeks or months after training. It is not known if the change in performance should be considered true change or inconsistent performance. The aim of this study was to investigate consistency and variability in human performance during iCPR. Methods An experimental, prospective, observational study conducted within a university setting with 27 healthcare students (mean (SD) age 32.6 (11.6) years, 74.1% female). On completion of paediatric basic life support (BLS) training, participants performed three trials of 2-min iCPR on a modified infant manikin on two occasions (immediately after training and after 1 week), where performance data were captured. Main outcome measures were within-day and between-day repeated measures reliability estimates, determined using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC95%) for chest compression rate, chest compression depth, residual leaning and duty cycle along with the conversion of these into quality indices according to international guidelines. Results A high degree of reliability was found for within-day and between-day for each variable with good to excellent ICCs and narrow confidence intervals. SEM values were low, demonstrating excellent consistency in repeated performance. Within-day MDC values were low for chest compression depth and chest compression rate (6 and 9%) and higher for duty cycle (15%) and residual leaning (22%). Between-day MDC values were low for chest compression depth and chest compression rate (3 and 7%) and higher for duty cycle (21%) and residual leaning (22%). Reliability reduced when metrics were transformed in quality indices. Conclusion iCPR skills are highly repeatable and consistent, demonstrating that changes in performance after training can be considered skill decay. However, when the metrics are transformed in quality indices, large changes are required to be confident of real change.
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Affiliation(s)
- Debora Almeida
- Faculty of Health and Social Sciences, Bournemouth University, R604, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, England. .,Department of Anesthesiology, Main Theatres, Royal Bournemouth and Christchurch Hospitals, Castle Lane East, Bournemouth, BH7 7DW, England.
| | - Carol Clark
- Faculty of Health and Social Sciences, Bournemouth University, R612, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, England
| | - Michael Jones
- Cardiff School of Engineering, Cardiff University, Cardiff, CF23 3AA, Wales
| | - Phillip McConnell
- Resuscitation Services, Heart Club, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, England
| | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, R611, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, England
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