P2D261: Resident Clinic Resuscitation Quality Improvement: An Educational Review and Intervention on Resident Comfort with Pediatric Resuscitation Carts in the Ambulatory Setting

Purpose/Objectives: Pediatric trainees are required to maintain Pediatric Advanced Life Support (PALS) certification during their residency. While this provides trainees with life-saving skills and knowledge of emergency supplies that are available in the hospital setting, most residents have not needed to apply these skills in case of emergency in the ambulatory and continuity clinic environment. In addition, there is no standardization between clinic sites regarding emergency supplies, code cart locations or ancillary staff emergency response training. To this end, our project aims to evaluate the knowledge gaps in resident education regarding outpatient emergency protocols.

Design/Methods: University of South Florida (USF) pediatric and med/peds residents at the PGY-1 to PGY-4 levels were surveyed regarding their comfort and knowledge of pediatric resuscitation cart locations, supplies and protocols at one of their ambulatory clinic sites. After distribution of the survey, residents reviewed an educational video that provided instruction on resuscitation cart use in clinic. A handout reinforced the education in the video and included photographs of location, supplies, and a list of key staff who would participate in a code in clinic.
After residents reviewed the educational materials, they completed the same survey to assess if there were changes in knowledge and comfort regarding outpatient management of resuscitation events. Resident comfort scales were completed on an ordinal scale of confidence (1= not confident, 5 = very confident). Three medical knowledge questions were asked based on items located within the carts which were graded nominally as correct or incorrect.

Results: A total of 26 residents completed the pre-survey questionnaire, of which 69% received our resuscitation cart education and completed the post-survey. Prior to receiving education 3.8% of residents were able to identify the location of the resuscitation cart in clinic, which improved to 100% after implementation of the educational video. Resident ability to identify location f resuscitation contents improved from 77% with minimal or no confidence to 0% minimal or no confidence. Medical knowledge of resuscitation cart contents between responders improved from a mean score of 25.9% correct to 70.3% correct after education implementation.

Conclusion/Discussion: Improving resident preparedness to apply life saving skills in unconventional settings will facilitate better health outcomes for patients and their families. Our study suggests that increased exposure to resource education within the ambulatory clinic setting can improve resident comfort in managing acute pathologies within the clinic. With our better understanding of specific gaps in resident education, we aim to establish standardized protocols for each of our clinic sites that will act as a foundation for simulation or orientation sessions for all members of the outpatient medical team.