Using Simulation Training to Enhance Communication During Code Events in the Cardiac Catheterization Lab

Purpose:
To improve communication among care givers during code events in the cardiac catheterization (cath) lab through participation in facilitated simulation code scenarios. Participation will improve patient care outcomes, advance quality of care and support collegial nurse-physician relations.

Significance:
The unique environment in the cardiac catheterization lab creates challenges for care givers participating in codes due to lack of role clarity and unclear communication. Delays in response to life threatening emergencies ultimately compromise patient care and optimal treatment outcomes.

Strategy and Implementation:
The focus was to improve communication among team members. All cath lab staff, cardiologists and cardiac anesthesiologists participated in “crew resource management” (CRM) training offered thru Safer HealthCare. Participation provided the foundation for discussion of concerns related to patient care and effective communication during codes. The cath lab leadership team implemented these process improvements 1) reference document describing specific roles during codes; 2) facilitated simulation training sessions utilizing “sim baby”; 3) identification of the characteristics within the cath lab environment impacting safety, such as angiographic equipment and limited direct access to the patient. The cath lab team now routinely utilizes the CRM process including safety checklists, huddles, hand-offs and de-briefings focusing on process. Code simulation using “sim baby” is an innovative strategy for the cath lab team. CRM expanded to include closed-loop-communication.

Evaluation:
Participants in the simulation codes completed an on- line evaluation survey after each simulation. Questions focused on perceived value of the simulation and how participation in the simulated codes contributed to improved outcomes during actual codes. Results of the survey will be available.

Implications for Practice:
Participation in simulated code events in a supported learning environment contributes to safer patient care during actual code events. Closed-loop communication and CRM eliminates barriers to effective communication. Increased staff awareness and accountability improves patient outcomes.