Code Blue Outcomes & Process Improvement Through Leadership Optimization Using Teleintensivists-Simulation
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,001
- 试验地点
- 7
- 主要终点
- Fraction of Pulseless Time With no Chest Compressions
研究概览
简要总结
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.
详细描述
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").
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •(on-site cardiac arrest team):
- •Are 18 years of age or older
- •Inclusion criteria (teleintensivist cardiac arrest team copilot):
- •Are 18 years of age or older
- •Are a board-certified or board-eligible critical care physician
- •Provide clinical care through the Intermountain Healthcare Telecritical Care program
排除标准
- •(both groups):
- •Are under 18 years of age
- •Are a member of the study research team
研究组 & 干预措施
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
干预措施: Tele-intensivist consultation (Other)
Control
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.
干预措施: Simulated "observation" by ICU physician (Other)
结局指标
主要结局
Fraction of Pulseless Time With no Chest Compressions
时间窗: From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)
次要结局
- 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))
- 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)
- 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)
- 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)
- 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)