Abstract 320: Simulation of Cardiac Arrhythmias in Hospitalized Patients to Measure and Improve Response Time
Introduction: Hospitals have limited means of assessing time to respond to in-hospital life-threatening cardiac arrhythmias. Metrics of time to recognition are lacking and effectiveness of remote monitoring is not well understood. We sought to determine whether it was feasible and valid to measure response time to arrhythmias by inserting simulated arrhythmias into ongoing in-hospital cardiac monitoring.
Hypothesis: We hypothesized that monitoring personnel would perceive a simulated arrhythmia, placed in the slot of a patient, as real and respond as such. We hypothesized that, compared to on-unit local monitoring (of monitors in the care area by direct care nurses), off-unit remote monitoring (of a bank of monitors by technicians), requiring more communication steps, would result in slower response time from arrhythmia onset to nurse-in-room.
Methods: We conducted 50 simulated life-threatening arrhythmias (Vfib or Vtach) at two hospitals. We measured time from start of simulated arrhythmia to nurse-in-room. We asked 40 nurses and 13 monitoring technicians whether they perceived the event to be “real” (not a simulation). We compared nurse-to-room times between 28 locally and 15 remotely-monitored patient arrhythmias using non-parametric Wilcoxon sum of ranks statistics.
Results: The event was interpreted as real by 38 of 40 nurses and 11 of 13 remote technicians. Among a subset (30 nurses, 6 technicians), about one-third, in hindsight, recalled aspects of the rhythm or work environment that could have cued them that the event was not real. Average nurse-to-room time for locally monitored patients was 23 seconds, significantly faster (p = 0.0002) than the 58 seconds required for remotely monitored patients.
Conclusions: This study provides preliminary evidence that arrhythmia simulators may be used to effectively measure recognition and response time to life-threatening cardiac arrhythmias. Careful implementation is required to ensure realism.
- © 2012 by American Heart Association, Inc.