A Confidence Boost: Utilizing Supplemental Education to Improve Ambulatory Care Emergency Responses

Background: In 2010, the American healthcare system experienced an increased growth in the ambulatory care setting with the enactment of the Affordable Care Act. As ambulatory care visits continue to increase, so does the potential for medical emergencies within the ambulatory care setting. It is imperative that the ambulatory care team is prepared to respond to medical emergencies involving patients, caregivers, and staff members.
Problem: In 2023, 18 pediatric specialty clinics that are located on the same campus as a large urban 486-bed medical center in Fort Worth, Texas, experienced a significant building expansion. The expansion brought an increase in patient visits and emergency medical alerts. The 2023/2024 fiscal year saw 142,077 clinic visits and 21 emergency medical alerts. Code debriefing identified staff’s lack of familiarity with the crash cart, code medication, defibrillator, and oxygen delivery devices and poor code documentation. Although current resuscitation training for clinical staff consisted of basic life support (BLS) in addition to pediatric advanced life support (PALS) every 2 years and an annual mock code in the simulation lab for nurses, staff voiced a lack of confidence in their ability to manage medical emergencies.
Method: The American Heart Association (AHA) has recognized this problem and recommends booster training events. A multimodal booster training approach was proposed to address the knowledge and skills gaps. The proposed multimodal education plan comprised of a combination of activities to include in situ low-fidelity mock codes, learning systems curricula, and hands-on training for the defibrillator, oxygen delivery devices, and documentation and a crash cart scavenger hunt. This QI project was based on the plan-do-study-act (PDSA) model. The PDSA provides a framework for testing changes, learning from each test, and refining changes through subsequent PDSA cycles.
Results: In 2024, the proposed education events were conducted onsite in eight specialty clinics over a three-month period. A baseline comfortability survey utilizing a 5-point Likert scale ranging from “not confident at all” to “very confident” was administered 30 days prior to the education events. Immediately upon completion of the events, a post-survey was completed. Each survey question indicated an increase in staff confidence. Upon comparison of the baseline and post-survey levels, the level of staff confidence reflected a mean increase ranging from 12% to 51% with an average overall increase of 27%.
Discussion: Survey results showed a significant increase in staff member confidence to perform the skills required for management of medical emergencies. Further assessment will need to take place to determine comfort retention. During the education process the need to include front desk staff in future training was identified. Front desk staff are often the first responders to medical events that happen in the patient waiting area and receive little to no training on the topic.
Implications/conclusions: The project’s positive results supports the AHA’s s guideline that the addition of booster training to resuscitation courses is associated with improved cardiopulmonary resuscitation skill retention over time.