Test cases: in-hospital, scenario-based cardiopulmonary resuscitation training
Johan Israelsson, Division of Cardiology, Department of Internal Medicine, Kalmar County Hospital, Lasarettsvägen, S-391 85 Kalmar, Sweden. Tel: 00 46 480 81130; Fax: 00 46 480 448797; E-mail: firstname.lastname@example.org
Context and setting
Test cases are a method for unannounced scenario-based cardiopulmonary resuscitation (CPR) training and evaluation. The aim of this feasibility study is to describe the method in a hospital setting. The test cases described were performed by advanced life support (ALS) instructors at a county hospital in northern Europe.
Why the idea was necessary
Many patients die from sudden cardiac arrest (SCA) inside hospitals all over the world. The survival rate is closely correlated with well-performed CPR, including time to first defibrillation. Earlier reports have claimed major deficiencies in CPR performance and skills retention and in hospital routines for CPR education and organisation. There are problems in translating skills from safe training environments to real SCA situations. The International Liaison Committee of Resuscitation (ILCOR) recommends more evaluation of additional training methods for health care professionals. This is, to our best knowledge, the first report of the use of test cases as a training and evaluation method.
What was done
From 3 May 2005 to 8 November 2008, 23 test cases were performed at different locations in the hospital. All involved personnel knew the test was going to take place, but they did not know when. They were instructed to act as in an authentic SCA situation. This included alarming the hospital medical emergency team (MET).
The MET also participated in the test cases to create realistic multidisciplinary training situations. A CPR training manikin (with a rhythm simulation module) was used to simulate the patient. A skills reporter, a protocol and a stopwatch were used for timing and technique assessment. The actions taken were assessed in relation to international guidelines. After the test cases, briefings were held with the personnel in order to allow them to express their points of view and to receive feedback regarding their performance. The focus was primarily on the team, but also on individual performances. All test cases were performed during office hours. The mean time from discovery of the manikin to first defibrillation was 2.73 ± 0.51 minutes (range 2.05–3.90 minutes). In eight of 23 cases, time to first defibrillation exceeded the stipulated 3 minutes. In all cases automated external defibrillators (AEDs) were used by nursing ward staff for the first defibrillation. The mean time to arrival of any of the members of the MET was 4.96 ± 1.70 minutes (range 3.05–9.80 minutes). The mean percentage of correctly performed chest compressions was 67.30 ± 24.99% (range 0–95%). The mean percentage of correctly performed ventilations was 40.00 ± 26.40% (range 0–90%).
Evaluation of results and impact
Test cases are feasible as an additional multidisciplinary training and evaluation method for in-hospital CPR. They create realism and can help in translating skills from safe training environments to real SCAs. They also provide baseline information regarding in-hospital CPR organisation. Further test cases are needed to show whether CPR performance can be improved using this method.