Simulating Targeted Temperature Management (TTM) in Post Resuscitative Care for Cardiac Arrest Patients

Background: Sudden cardiac arrest accounts for 15% of mortality in industrialized nations. Once circulation has been restored through successful CPR and defibrillation, post rescuciation care with TTM is important to prevent further damage to the brain tissue and other organ systems. Full interprofessional collaboration with proper communication and leadership are crucial facilitators to effective team function and improved patient outcomes. Medical simulations are an effective teaching tool for healthcare teams, allowing for education on practices while improving interprofessional teamwork behaviors.
Objectives: The goal of this project was to develop and implement a pilot simulation to improve knowledge of the Targeted Temperature Management (TTM) guideline and improve how interprofessional teams collaborate after participation in a simulation.
Methods: This was a pilot study in a 650 bed academic institution in central Virginia, with a 56 bed ED, and two out of five adult ICUs. Six simulations were conducted with four-to-six clinicians in a mix of nurses and physicians. Participants completed a pretest, short class with a handout on TTM, a simulation with scenario tailored to clinical area with debriefing and a completed posttest.
Results: Originally 29 participants were confirmed; a total of 20 completed the entire simulation experience. Significance was obtained for all questions related to knowledge of TTM competence between pre and post-test scores (p=< 0.001). The difference on feelings of working in an interprofessional team and how the simulation affected that, achieved significance (p=0.003). There was a perfect correlation for clinical experience of four-to-ten years in knowledge score of TTM and feelings of working in interprofessional teams.
Conclusions: The majority of participants felt the simulation helped them to understand TTM and how to use it in the clinical setting. The results show improvement in significance of knowledge gaps. The location of the simulation in the hospital and overall fidelity had little to no impact on the overall results. The staffing constraints affected participants’ ability to volunteer and/or follow through with commitment to the simulation. The teams wanted to focus on TTM during the debriefing and not on teamwork aspects. A structured and validated tool based on interprofessional literature should be used in the future to define different aspects of teamwork and allow more reflection and discussion for participants to collaborate better in the clinical setting. The simulation needed a format of multiple days, one for TTM focus with more challenging scenarios, and the other for interprofessional team focus. The role of an APRN prepared as a DNP can use simulations to engage in the process improvement activities and challenge the status quo of individual clinicians because of their experience in system level leadership.