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Acute coronary syndrome and cardiac arrest: using simulation to assess resident performance and program outcomes.

ABSTRACT: BACKGROUND: Simulation training has emerged as an effective method of educating residents in cardiac emergencies. Few studies have used emergency simulation scenarios as an outcome measure to identify training deficiencies within residency programs. PURPOSE: The purpose of this study was to evaluate postgraduate year-1 (PGY-1) residents on their ability to manage an acute coronary syndrome and cardiac arrest scenario before and after internship in order to provide outcome data to improve program performance. METHODS: A total of 58 PGY-1 residents from 10 medical specialties were evaluated using a human patient simulator before and after internship. They were given 12 minutes to manage a patient with acute coronary syndrome and ventricular fibrillation due to hyperkalemia. An objective checklist following basic and advanced cardiac life support guidelines was used to assess performance. RESULTS: A total of 58 interns (age, 25 to 44 years [mean, 29.1]; 38 [65.6%] men; 41 [70.7%] allopathic medical school graduates) participated in both the incoming and outgoing examination. Overall chest pain scores increased from a mean of 60.0% to 76.1% (P < .01). Medical knowledge performance improved from 51.1% to 76.1% (P < .01). Systems-based practice performance improved from 40.9% to 71.0% (P < .01). However, patient care performance declined from 93.4% to 80.2% (P < .01). CONCLUSIONS: A simulated acute coronary syndrome and cardiac arrest scenario can evaluate incoming PGY-1 competency performance and test for interval improvement. This assessment tool can measure resident competency performance and evaluate program effectiveness.

SUBMITTER: Opar SP

PROVIDER: S-EPMC2951781 | biostudies-other | 2010 Sep

REPOSITORIES: biostudies-other

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Project description:ImportanceSurvival rates after in-hospital cardiac arrest (IHCA) vary significantly among US centers; whether this variation is owing to differences in IHCA care quality is unknown.ObjectiveTo evaluate hospital-level variation to determine whether hospital process composite performance measures of IHCA care quality are associated with patient outcomes.Design, setting, and participantsUsing data from the American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) program, we analyzed 35 283 patients 18 years or older with IHCA treated at 261 US hospitals from January 1, 2010, through December 31, 2012. We calculated the hospital process composite performance score for IHCA using 5 guideline-recommended process measures. Opportunity-based scores were calculated for all patients, aggregated at the hospital level, divided into quartiles, and then associated with risk-standardized survival and neurologic status by a test for trend. The scores were then evaluated through hierarchical logistic regression and reported as odds ratios per 10% increment in hospital process composite performance.InterventionsAcute care treatments for IHCA.Main outcomes and measuresThe primary outcome was survival to discharge measured as risk standard survival rates, and the secondary outcome was favorable neurologic status at hospital discharge.ResultsOf the 35 283 adults included in this study, the median age was 67 years (interquartile range [IQR] 56-78 years), and 57.9% were male. The median IHCA hospital process composite performance was 89.7% (interquartile range, 85.4%-93.1%) and varied among hospital quartiles from 82.6% (lowest) to 94.8% (highest). The IHCA hospital process composite performance was linearly associated with risk-standardized hospital survival to discharge rates: 21.1%, 21.4%, 22.8%, and 23.4% from lowest to highest performance quartiles, respectively (P < .001). After adjustment, each 10% increase in a hospital's process composite performance was associated with a 22% higher odds of survival (adjusted odds ratio, 1.22; 95% CI, 1.08-1.37; P = .01). Hospital process composite quality performance was also associated with favorable neurologic status at discharge (P = .004).Conclusions and relevanceThe quality of guideline-based care for IHCA varies significantly among US hospitals and is associated with patient survival and neurologic outcomes.

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Acute coronary syndrome and cardiac arrest: using simulation to assess resident performance and program outcomes.

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