ABSTRACT
High-fidelity simulation training in CPR (CPR-HFST) could identify weaknesses in pre-COVID-19 Code Blue (CB) practices. Importantly, PPE donning may delay CPR thus worsening patient outcomes. We sought to determine the effect of our CPR-HFST on clinical practice. A retrospective review of CB events in a 1000-bedded hospital, pre- and intra-pandemic was conducted from 01/05/2019 to 30/10/2020. Onset of the pandemic was taken as 04/02/2020. CPR-HFST commenced in January 2020. The primary objective was to determine pre- and intra-pandemic response times. Intubation times, patient outcomes (quantified by CB survival rates and the CPC score), and incidence of HCW infection were our secondary objectives. The CCI score was used to stratify patients with similar comorbidities. Two-tailed Chi-square and Mann-Whitney tests were used for statistical comparisons, alpha = 0.05. 158 CB events were reviewed. Median response time was longer intra-pandemic compared to prepandemic;4.0 mins (IQR: 3-5) vs. 3.0 mins (IQR:1-4), p=0.0007. Cardiac rhythms were asystole (25.5%), PEA (53.8%), VT (5.7%), and VF (11.3%). 67.1% of patients required CPR, of which, 88.7% were intubated. There were no significant differences in median intubation times: 12.0 (prepandemic) vs. 11.0 mins (intra-pandemic), p=0.89. Survival to hospital discharge were similar;14.1% (pre-pandemic) vs. 21.4% (intra-pandemic), p=0.33. We did not find any significant differences in survival rates and CPC scores (Table 1). There were no HCW infections. Survival to hospital discharge rates of patients requiring in-hospital CPR may be lower intrapandemic;Miles et al reported 3.2% vs 12.8% respectively, p<0.01. These were significantly different compared to our intra-pandemic cohort (3.2% vs. 21.4%, p<0.01) but not in our pre-pandemic cohort (12.8% vs. 14.1%, p=0.82). Reasons for the differences are likely multifactorial. Nonetheless, in our experience and data, we believe CPR-HFST prevents deterioration in the standards of care and may help in optimising CPR outcomes. (Table Presented) .
ABSTRACT
BACKGROUND: Diabetic Foot Osteomyelitis (DFO) is a common infection where treatment involves multiple services including Infectious Disease (ID), Podiatry, and Pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking. METHODS: Representatives from ID, Podiatry, and Pathology interested in quality improvement (QI) developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to DFO. Knowledge acquisition was assessed by pre- and post-intervention surveys. Inpatients with forefoot DFO were retrospectively reviewed pre- and post- intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses. RESULTS: A post-intervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the pre-intervention cohort (4/1/2018-4/1/2019) and 32 patients in the post-intervention cohort (11/5/2019-03/01/2020), the latter truncated by changes in hospital practice during the COVID-19 pandemic. Non-categorizable or equivocal pathology reports decreased from pre-intervention to post-intervention (27.0% vs 3.3%, respectively, P=0.006). We observed non-significant improvement in correct bone margin definition (74.0% vs 87.5%, p=0.11), unnecessary PICC line placement (18.3% vs 9.4%, p=0.23), and unnecessary prolonged antibiotics (21.9% vs 5.0%, p=0.10). Additionally, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients. CONCLUSIONS: This QI initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and non-significant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.