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

Study Overview
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Brief Summary
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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
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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).

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

Conditions
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Cardiac Arrest

Intervention / Treatment
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* Other: Tele-intensivist consultation
* Other: Simulated observation by ICU physician


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tele-intensivist consultation<br>Standardized consultation to on-site cardiac arrest response team by off-site intensivist via two-way audiovisual link using a mobile telemedicine cart | Other: Tele-intensivist consultation<br>* Standardized consultation to on-site cardiac arrest team by off-site intensivist via two-way audiovisual link using a mobile telemedicine cart<br>|
| Placebo Comparator: Control<br>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. | Other: Simulated observation by ICU physician<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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) | 
| 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) | 
| Time to first dose of epinephrine |  | 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 | 
| ACLS protocol errors (using checklist adapted from McEvoy ACLS assessment tool) |  | 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 | 
| Types of input by telemedical intensivist copilot |  | From initiation of simulation through termination of simulation, an average of 15 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 | Immediately after simulation | 
| Short form State-Trait Anxiety Inventory score |  | Immediately after simulation | 
| Presence of telemedicine audiovisual connection problems per intervention group simulation event |  | From initiation of simulation through termination of simulation, an average of 15 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Code blue, Code team, Crisis team leadership, Cardiopulmonary resuscitation, Telemedicine, Simulation, Mock code, In-hospital cardiac arrest