(720) Adherence to Resuscitation Ergonomics Amid High Rates of PICU Staff Turnover

Introduction: Each year in the United States, there are more than 6000 pediatric in-hospital cardiac arrests (IHCA), with the majority of these occurring in the PICU. Most children who sustain an IHCA will not survive. Variability amongst hospital survival rates exist, which indicates an opportunity to improve survival by decreasing errors and optimizing resuscitation performance. Resuscitation ergonomics improves patient outcomes by optimizing the interaction of the environment with human factor driven behaviors.

During the pandemic, we experienced high rates of staff turnover leading to an influx of staff with variable resuscitation ergonomic training, known as Team-Training, at our institution. The purpose of this study was to determine the optimal number of Team-Trained staff on a resuscitation team needed to maintain high-quality resuscitation ergonomics during an IHCA, as defined by a checklist we developed using resuscitation science literature, Failure Mode and Effect Analysis testing at CHOA, and American Heart Association recommendations.

Methods: Demographic data was collected for all PICU staff including completion of Team-Training in 2021. After each IHCA, A Resuscitation Ergonomics Compliance Assessment was filled out to assess the maintenance of resuscitation ergonomics. We divided the total number of IHCAs into three groups based on the percentage of Team-Trained staff present at the IHCA: low(≤25%), moderate(26-50%), and high(>50%).

Results: We collected data on 42 IHCAs. Total compliance scores were calculated and summarized using means and standard deviations. Pairwise evaluations for differences in mean total compliance scores were evaluated using Cohen’s d differences which looks at effect size differences between groups. Compared to low Team-Trained teams, moderate and high Team-Trained teams had more mean items endorsed, corresponding to large (Cohen’s d=0.83 and d=1.12) effect size differences.

Conclusions: A higher percentage of Team-Trained staff correlated with higher compliance of resuscitation ergonomics best practices. Further analysis identified which high-quality ergonomics are performed the least. This will guide and improve our resuscitation training. Data from this study will serve as building blocks for the system-wide introduction of the CPR coach resuscitation role.