Evaluating the ergonomics of cardiac arrest care

Purpose: To identify the ideal physical setup that maximizes vital equipment visibility for the resuscitation team to allow rapid assessment of cardiac rhythms during pulse checks, real-time feedback on CPR quality, and better identification of the team leader.Design: Quality Improvement (QI) project.Setting: Adult Emergency Department in an urban, academic, level I trauma and tertiary referral center treating over 70,000 patients per year.Participants/Subjects: Key stakeholders involved in cardiac arrest care were identified and invited to participate in a simulation exercise during the 2014-15 and 2015-16 academic year. Participants in these simulation evaluations were Johns Hopkins Adult Emergency Department and ancillary staff including, but not limited to: Attending physicians, resident physicians, registered nurses, clinical technicians, support associates, pharmacy, human factors engineers, and health science informaticians.Methods: A simulated cardiac arrest case, utilizing a medium-fidelity mannequin, was performed with participants playing usual resuscitation team roles in various ergonomic layouts utilizing an iterative approach to improve the 2015-16 academic year design. A multidisciplinary quality improvement team created a new design proposal based on feedback and results from the prior year's simulation sessions and this layout (attached) was evaluated. Qualitative feedback was collected via immediate post-simulation surveys to assess: Zoll cardiac resuscitation device visibility, team leader identification, other team member identification, communication, and equipment access. CPR quality was measured and recorded during the simulation.Results/Outcomes: Data from survey results identified significant improvement. Zoll visibility, 4.7-5 on a 5-point scale, improved 62% from the standard layout (2.9-5). The team leader rated 5 from all participants and communication increased to 4.7 compared to 4.5 rating in standard layout.Implications: There is limited published literature addressing the impact of ergonomics on CPR quality during Emergency Department resuscitations. We used an iterative, multi-disciplinary, simulation-based approach to generate an optimal physical layout that would improve the resuscitation team's ability to 1) obtain continuous, real-time feedback on the quality of delivered CPR; 2) quickly identify cardiac rhythm on pulse checks; and 3) identify the team leader. We quantified the impact of these layout changes using team surveys. The next steps are to measure how performance standards, as defined by the American Heart Association, are affected by the change in CPR ergonomics.