DP37: ENHANCING EMERGENCY PREPAREDNESS IN THE AMBULATORY PACU: A QUALITY IMPROVEMENT INITIATIVE UTILIZING IN SITU MOCK CODES AND RESUSCITATION CART OPTIMIZATION
Joon Yoo, MD; Leonardo Pena, MD; Kathryn Boles, DO, PharmD, MPH
HCA FL Oak Hill Hospital/USF Morsani College of Medicine
Introduction: Ambulatory surgery centers (ASCs) are designed for efficient perioperative care and rapid patient turnover, but low-frequency, high-risk emergencies still occur in post-anesthesia care units (PACUs). Unlike hospital-based PACUs, ambulatory PACUs operate with smaller teams and lack immediate access to ICU-level resources, making efficient emergency response critical. Despite ACLS/BLS training, knowledge and skill retention decline rapidly, increasing the risk of resuscitation delays. Prior studies show in situ mock codes improve provider confidence, role clarity, and adherence to ACLS protocols, but their use in ambulatory settings remains limited. This quality improvement (QI) project aimed to enhance emergency response preparedness in an ambulatory PACU through a structured mock code and resuscitation cart reorganization to improve airway equipment accessibility.
Methods: A pre-intervention survey was distributed to PACU nurses, anesthesiologists (attendings and residents), and CRNAs to assess confidence, preparedness, and familiarity with emergency protocols and resuscitation cart organization. The survey used a 1-10 Likert scale for numerical evaluation. An in situ mock code was conducted in the ambulatory PACU, simulating a perioperative cardiac arrest scenario with a focus on airway management, adherence to ACLS protocols, and team communication. The resuscitation cart was reorganized to improve airway supply accessibility, and visual aids were added for equipment location. A post-intervention survey using identical metrics was administered to measure changes in provider confidence, preparedness, and equipment familiarity. Paired pre- and post-intervention survey results were analyzed using a paired t-test to assess statistical significance.
Results: A total of 27 providers participated, including 11 PACU nurses, 9 anesthesiologists (4 residents, 5 attendings), and 3 CRNAs. Post-intervention survey results demonstrated significant improvements. Confidence in participating in a PACU code increased from 6.3 to 9.2 (p < 0.001), and familiarity with resuscitation cart organization improved from 3.2 to 7.8 (p < 0.001). Self-reported readiness to manage PACU emergencies increased from 5.8 to 8.6 (p = 0.002). Participants also reported a significant increase in their ability to locate and use airway equipment efficiently, with scores improving from 5.1 to 8.9 (p < 0.001).
While improvements were observed across all measured domains, not all changes reached statistical significance. Confidence in adhering to ACLS protocols improved from 7.2 to 7.7, but this was not statistically significant (p = 0.12). Perception of overall team communication improved from 6.6 to 7.2 but did not reach significance (p = 0.09). Qualitative feedback highlighted enhanced role clarity, faster response times, and better team coordination. Some participants noted lingering challenges in ensuring clear leadership during code situations.
Conclusion: This QI initiative demonstrated that in situ mock codes, coupled with resuscitation cart reorganization, significantly improved provider confidence, preparedness, and emergency response skills in the ambulatory PACU. Given the unique challenges of ASCs, mock code training and equipment standardization should be considered best practices to enhance emergency preparedness in resource-limited environments. Future studies should explore sustained skill retention and the impact of repeated mock codes over time. Expanding mock code training to additional ambulatory perioperative areas may further improve response times and outcomes in critical situations.
