Code Blue Outcomes & Process Improvement Through Leadership Optimization Using Teleintensivists-Simulation

Not Applicable

Completed

Conditions: Cardiac Arrest

Interventions: Other: Tele-intensivist consultation
Other: Simulated "observation" by ICU physician

Registration Number: NCT03000829

Lead Sponsor: Intermountain Health Care, Inc.

Brief Summary: This multicenter randomized trial will employ in-situ cardiac arrest simulations ("mock codes") to test whether using telemedicine technology to add an intensive care physician as the "copilot" for cardiac arrest resuscitation teams influences chest compression quality, resuscitation protocol adherence, team function, and provider experience.

Detailed Description: Only 15-30% of patients who suffer in-hospital cardiac arrest (IHCA) survive to hospital discharge. Factors associated with lower mortality and improved function include provision of high-quality, minimally-interrupted chest compressions and swift defibrillation of eligible arrhythmias. Unfortunately, resuscitation teams provide suboptimal care to 25-40% of IHCA victims. A dedicated IHCA team "copilot" may improve resuscitation team performance by providing the team leader with parallel analysis, situational awareness augmentation, action checking, protocol verification, and error correction. Critical care physician involvement via a telemedicine link could allow experienced specialists to fill the "copilot" role in a cost and resource-efficient manner, particularly in smaller hospitals with fewer available physicians.

The current study will evaluate how consultation by an off-site intensive care physician via a telemedicine link influences local IHCA teams' quality of care, team function and provider experience during simulated cardiac arrest events ("mock codes").

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 1001

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Tele-intensivist consultation	Tele-intensivist consultation	Standardized consultation to on-site cardiac arrest response team by off-site intensivist via two-way audiovisual link using a mobile telemedicine cart
Control	Simulated "observation" by ICU physician	Simulated "observation" by ICU physician by displaying a silent, pre-recorded, non-interactive videotape of an ICU physician. The on-site participants will be told that an intensive care physician is observing the mock code.

Primary Outcome Measures

Name	Time	Method
Fraction of Pulseless Time With no Chest Compressions	From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)

Secondary Outcome Measures

Name	Time	Method
Presence of Telemedicine Audiovisual Connection Problems for Intervention Group Simulation Event	From initiation of simulation through termination of simulation, an average of 15 minutes
Time to First Dose of Epinephrine	From initiation of simulation through termination of simulation, an average of 15 minutes
Team Emergency Assessment Measure Score	From initiation of simulation through termination of simulation, an average of 15 minutes	The validated "Team Emergency Assessment Measure (TEAM)" evaluates non-technical performance of the on-site resuscitation team. The score (range 0-4) for each simulation was obtained by averaging the mean score for each of 11 component scores (each component item scored 0-4, with higher values representing better performance).
Overall ACLS Protocol Adherence (Using Checklist Adapted From McEvoy ACLS Assessment Tool)	From initiation of simulation through termination of simulation, an average of 15 minutes
Short-form State-Trait Anxiety Inventory Score	Immediately after simulation	The short-form State-Trait Anxiety Inventory (STAI) measures acute stress experienced by respondents using 6 questions (scores for each question range from 1 to 4, with higher values indicating more stress). Analyzed respondent-level values use the total score (range 4-24) obtained by summing the score for each of the six questions, with higher values indicating more respondent-reported acute stress.
Time From Onset of Shockable Rhythm to Defibrillation	From onset of simulated VF or VT until first defibrillation or end of simulation
Fraction of Chest Compressions With Complete Release	From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)
Opinions of Study Subjects About Experience Participating in Simulated Cardiac Arrest, Using a Locally-developed and Validated Survey Instrument	Immediately after simulation	Measured domains: understanding of telemedicine intensivist copilot's role, beliefs about telemedicine intensivist copilot's ability to integrate with on site team, ability to influence on-site team performance, comfort with telemedicine intensivist copilot's role, and function of telemedicine interface
Fraction of Chest Compressions at Target Rate	From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)
ACLS Protocol Errors (Using Checklist Adapted From McEvoy ACLS Assessment Tool)	From initiation of simulation through termination of simulation, an average of 15 minutes
Types of Input by Telemedical Intensivist Copilot	From initiation of simulation through termination of simulation, an average of 15 minutes

Trial Locations

Locations (7): LDS Hospital
🇺🇸
Salt Lake City, Utah, United States
American Fork Hospital
🇺🇸
American Fork, Utah, United States
McKay-Dee Hospital
🇺🇸
Ogden, Utah, United States
Park City Hospital
🇺🇸
Park City, Utah, United States
Intermountain Medical Center
🇺🇸
Murray, Utah, United States
Riverton Hospital
🇺🇸
Riverton, Utah, United States
The Orthopedic Specialty Hospital
🇺🇸
Murray, Utah, United States