title: "Rolling Refreshers": a novel approach to maintain CPR psychomotor skill competence.
abstract: OBJECTIVE
  High quality CPR skill retention is poor. We hypothesized that "just-in-time" and "just-in-place" training programs would be effective and well-accepted to maintain CPR skills among PICU staff.
  
  
  METHODS
  "Rolling Refreshers", a portable manikin/defibrillator system with chest compression sensor providing automated corrective feedback to optimize CPR skills, were conducted daily in the PICU with multidisciplinary healthcare providers. Providers practiced CPR until skill success was attained, prospectively defined as <3 corrective prompts within 30s targeting chest compression (CC) rate 90-120/min, CC depth > 38 mm during continuous CPR. Providers completing > or =2 refreshers/month (Frequent Refreshers [FR]) were compared to providers completing < 2 refreshers/month (Infrequent Refreshers [IR]) for time to achieve CPR skill success. Univariate analysis performed using non-parametric methods. Following actual cardiac arrests, CPR providers were surveyed for subjective feedback on training approach efficacy (5-point Likert scale; 1=poor to 5=excellent).
  
  
  RESULTS
  Over 15 weeks, 420 PICU staff were "refreshed": 340 nurses, 34 physicians, 46 respiratory therapists. A consecutive sample of 20 PICU staff was assessed before subsequent refresher sessions (FREQ n=10, INFREQ n=10). Time to achieve CPR skill success was significantly less in FREQ (median 21s, IQR: 15.75-30s) than in INFREQ (median 67s, IQR: 41.5-84s; p<0.001). Following actual resuscitations, CPR providers (n=9) rated "Rolling Refresher" training as effective (mean=4.2; Likert scale 1-5; standard deviation 0.67).
  
  
  CONCLUSIONS
  A novel "Rolling Refresher" CPR skill training approach using "just-in-time" and "just-in-place" simulation is effective and well received by PICU staff. More frequent refreshers resulted in significantly shorter times to achieve proficient CPR skills.
authors.affiliation: Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA. niles@email.chop.edu
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Aaron
authors.initials: A
authors.lastname: Donoghue
authors.forename: Mandip S
authors.initials: MS
authors.lastname: Kalsi
authors.forename: Kathryn
authors.initials: K
authors.lastname: Roberts
authors.forename: Lori
authors.initials: L
authors.lastname: Boyle
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.forename: Mark
authors.initials: M
authors.lastname: Helfaer
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000523:psychology*; D002648:Child; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008348:Manikins; D011361:Professional Competence / Q000592:standards*; D011597:Psychomotor Performance