title: Improving code team performance and survival outcomes: implementation of pediatric resuscitation team training.
abstract: OBJECTIVE
  To determine whether implementation of Composite Resuscitation Team Training is associated with improvement in survival to discharge and code team performance after pediatric in-hospital cardiopulmonary arrest.
  
  
  METHODS
  We conducted a prospective observational study with historical controls at a 302-bed, quaternary care, academic children's hospital. Inpatients who experienced cardiopulmonary arrest between January 1, 2006, and December 31, 2009, were included in the control group (123 patients experienced 183 cardiopulmonary arrests) and between July 1, 2010, and June 30, 2011, were included in the intervention group (46 patients experienced 65 cardiopulmonary arrests).
  
  
  METHODS
  Code team members were introduced to Composite Resuscitation Team Training and continued training throughout the intervention period (January 1, 2010-June 30, 2011). Training was integrated via in situ code blue simulations (n = 16). Simulations were videotaped and participants were debriefed for education and process improvement. Primary outcome was survival to discharge after cardiopulmonary arrest. Secondary outcome measures were 1) change in neurologic morbidity from admission to discharge, measured by Pediatric Cerebral Performance Category, and 2) code team adherence to resuscitation Standard Operating Performance variables.
  
  
  RESULTS
  The intervention group was more likely to survive than the control group (60.9% vs 40.3%) (unadjusted odds ratio, 2.3 [95% CI, 1.15-4.60]) and had no significant change in neurologic morbidity (mean change in Pediatric Cerebral Performance Category 0.11 vs 0.27; p = 0.37). Code teams exposed to Composite Resuscitation Team Training were more likely than control group to adhere to resuscitation Standard Operating Performance (35.9% vs 20.8%) (unadjusted odds ratio, 2.14 [95% CI, 1.15-3.99]). After adjusting for adherence to Standard Operating Performance, survival remained improved in the intervention period (odds ratio, 2.13 [95% CI, 1.06-4.36]).
  
  
  CONCLUSIONS
  With implementation of Composite Resuscitation Team Training, survival to discharge after pediatric cardiopulmonary arrest improved, as did code team performance. Demonstration of improved survival after adjusting for code team adherence to resuscitation standards suggests that this may be a valuable resuscitation training program. Further studies are needed to determine causality and generalizability.
authors.affiliation: 1Center for Nursing Excellence, Lucile Packard Children's Hospital, Palo Alto, CA. 2Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, CA. 3Department of Pediatrics, Stanford University, Palo Alto, CA. 4Division of Trauma Services, Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, CA. 5Center for Quality Effectiveness and Process Improvement, Lucile Packard Children's Hospital, Palo Alto, CA. 6Division of Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA. 7Division of Pediatric Critical Care, Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, CA.
authors.forename: Lynda J
authors.initials: LJ
authors.lastname: Knight
authors.forename: Julia M
authors.initials: JM
authors.lastname: Gabhart
authors.forename: Karla S
authors.initials: KS
authors.lastname: Earnest
authors.forename: Kit M
authors.initials: KM
authors.lastname: Leong
authors.forename: Andrew
authors.initials: A
authors.lastname: Anglemyer
authors.forename: Deborah
authors.initials: D
authors.lastname: Franzon
mesh_terms: D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D057209:Hospital Rapid Response Team; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation / Q000592:standards*; D015996:Survival Rate; D016896:Treatment Outcome