Eastern Regional Meeting - 2008 Program & Abstracts
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PEDIATRIC MOCK CODES: IMPROVING RESIDENT RESUSCITATIONS
P. Zaveri, D. Friedman, K. O'Connell, Emergency Medicine and Trauma Center, Children's National Medical Center, Washington, DC
Purpose of Study: Resuscitation of the acutely ill child is a necessary skill for pediatric residents. The effects of an institution-wide mock code program on involvement, anxiety, and leadership have not been studied. The hypotheses were that after one year of a mock code program, pediatric residents would report 1) increased participation in codes, 2) decreased anxiety and increased comfort with knowledge needed in codes, and 3) increased likelihood of leading codes and feeling capable running a code.
Methods Used: In this cross-sectional study of pediatric residents, anonymous surveys evaluated personal assessment of involvement, comfort and leadership in codes before (PRE) and one year after (POST) a monthly mock code curriculum was implemented. The survey measured residents’ involvement in actual and mock codes as well as self-reported levels of anxiety, knowledge and leadership ability (using a Likert scale of 1-5) when faced with coding patients. In comparing PRE and POST results, we use medians for objective answers and odds ratios for subjective responses.
Summary of Results: There were 93 residents PRE and 63 POST. Attendance at real and mock codes is shown in the Table. POST residents were half as likely as PRE to report being anxious or extremely anxious with a coding patient (OR 0.47, 0.22-0.99) and were 3 times as likely to feel somewhat comfortable or better with their knowledge to manage a code (OR 3.16, 1.6-6.2). POST residents were no more likely to lead a code (OR 0.78, 0.3-1.9); however, they were more than twice as likely to feel somewhat capable or better running a code (OR 2.25, 1.0-5.0).
Conclusions: After instituting a mock code program, residents attended more mock codes, reported being less anxious and more knowledgeable in codes, and felt more capable running a code. This did not translate into more experience running actual codes. A monthly mock code program will provide residents with critical skills training and experience, and may translate into active participation and leadership in actual patient codes.
Attendance at Codes
| |
PRE Median* |
POST Median* |
p-value |
| Actual codes attended |
3-5 (1,9) |
3-5 (3,9) |
0.061 |
| Actual codes with an active role |
1-2 (0,5) |
1-2 (1,5) |
0.093 |
| Mock codes observed |
1-2 (1,2) |
3-5 (1,5) |
<0.001 |
| Mock codes participated |
1-2 (0,2) |
<3-5 (1,5)/td>
| <0.001 |
*Presented as range of attendance, n (IQR)
|
