Background: Hospital based providers are often tasked with leading cardiopulmonary arrest resuscitations known as code blues. This responsibility can be stress provoking and poorly executed without appropriate training resulting in poor patient outcomes. At our academic medical center, internal medicine residents on their inpatient hospital based rotations are responsible for this assignment. The process of ensuring providers are prepared for this responsibility is poorly defined.
Purpose: Implementation of a standardized written and simulation-based code leader examination to ensure hospital based medical resident competence for leading code blue scenarios while also improving their perceived level of preparedness for this task.
Description: Following a year-long code training course in the simulation center, categorical internal medicine residents were assigned to 1 of 4 sessions to complete a written and simulated examination. The written component consisted of 20 code blue-related questions. The simulated component consisted of 2 code blue scenarios, 1 shockable and 1 non-shockable rhythm case. A score of 80.0% or better on each component was required to pass. All categorical medical residents participated and were given direct feedback following their simulated experience. A post-intervention survey was sent to each participant and based on responses demonstrating an improvement in mean scores for perceived preparedness 64% to 73% (p-value 0.098) to be code leader, this course was repeated the following year which again demonstrated an improved post-intervention perceived preparedness response 48% to 75% (p-value 0.0048).
Conclusions: Implementation of a standardized written and simulation-based code leader examination after a year-long course provided a formal process to evaluate internal medicine residents, give feedback prior to promotion to code leader, and increase the level of provider preparedness for this role. This concept could be applied to any hospitalist program responsible for leading codes and looking for a more standardized approach to ensuring competency and comfort for this task.
