Kyle Lenz, MD
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Gayathri Prabhakar, MD
Hospitalist Physician
The Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Leslie Kersun, MD MSCE MSEd
Professor of Clinical Pediatrics
The Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Donald Boyer, MD, MSEd
Associate Professor of Clinical Anesthesiology and Critical Care
The Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Title: The Fast Five: Development of Learning Objectives for a Pediatric Resident Code Curriculum
Introduction: Out-of-ICU codes are among the most high-stakes events for medical providers and patients, requiring quick action and interdisciplinary collaboration. There are currently no standard expectations for pediatric residents in the initial five minutes of a code prior to arrival of the code team. The Fast Five aims to establish an educational curriculum informed by expert opinion from a multidisciplinary group of providers via focus groups and surveys.
Methods: Focus groups were conducted with pediatric critical care medicine (CCM) respiratory therapists, nurses and physicians regarding their experiences with out-of-ICU code responses. Responses were integrated into an online survey asking providers to choose the most important actions to be performed in the first five minutes by a frontline provider during various floor code scenarios: hypoxia, pulselessness, septic shock and status epilepticus. Surveys were distributed to CCM providers, general pediatrics attendings, and floor nurses and respiratory therapists. Using a modified Delphi method, group answers were compiled and sent back to participants for three total rounds. Answers with < 5% selection were eliminated to obtain consensus.
Results: Four focus groups were held with 12 total participants. Groups emphasized optimal setup of the environment and equipment over medical management. The first round of the survey was distributed to 565 participants with 167 responses (30%) and the second round was sent out to these 167 with 92 responses (55%). In the hypoxia and pulseless scenarios, bag-mask ventilation had >50% selection across two survey rounds (hypoxemia: 86% R1, 77% R2; pulseless: 70% R1, 82% R2). In the sepsis scenario, administration of IV fluids and IV access remained >50% whereas attachment of monitors declined from 56% R1 to 30% R2. The status epilepticus scenario had the greatest degree of discord with 6 tasks chosen more >20%.
Conclusions: Through two rounds of surveys, group consensus has not been obtained, but several important patterns have emerged. A small subset of tasks remains important across multiple code scenarios, suggesting a target for resident training. A third round of surveys will be distributed to obtain further consensus and these skills will ultimately be integrated into a mock code curriculum for pediatric residents.