Code Blue Outcomes & Process Improvement Through Leadership Optimization Using Teleintensivists-Simulation (COPILOT-Sim)

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

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

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.

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").

Code blue, Code team, Crisis team leadership, Cardiopulmonary resuscitation, Telemedicine, Simulation, Mock code, In-hospital cardiac arrest

Standardized consultation to on-site cardiac arrest response team by off-site intensivist via two-way audiovisual link using a mobile telemedicine cart

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.

Standardized consultation to on-site cardiac arrest team by off-site intensivist via two-way audiovisual link using a mobile telemedicine cart

Display of silent, pre-recorded, non-interactive videotape of an ICU physician. The on-site cardiac arrest team will be told that an intensive care physician is observing the mock code.

From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)

From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)

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

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

Inclusion criteria (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 Exclusion criteria (both groups): Are under 18 years of age Are a member of the study research team

Anonymized data will be available, after relevant IRB approval, by application to the principal investigator and Intermountain Office of Research.

Silva JAM, Mininel VA, Fernandes Agreli H, Peduzzi M, Harrison R, Xyrichis A. Collective leadership to improve professional practice, healthcare outcomes and staff well-being. Cochrane Database Syst Rev. 2022 Oct 10;10(10):CD013850. doi: 10.1002/14651858.CD013850.pub2.

Peltan ID, Guidry D, Brown K, Kumar N, Beninati W, Brown SM. Telemedical Intensivist Consultation During In-Hospital Cardiac Arrest Resuscitation: A Simulation-Based, Randomized Controlled Trial. Chest. 2022 Jul;162(1):111-119. doi: 10.1016/j.chest.2022.01.017. Epub 2022 Jan 19.