LAUSR

Learning Objectives: In cardiac arrest/rapid response (CA/RR) situations, the leader must be able to quickly identify members and provide them with directed commands so tasks are performed in a timely fashion. We hypothesize that jerseys for team members would increase directed commands and decrease time to perform critical actions. Methods: Internal Medicine Interns (n=48) were randomized into 4 groups. In group 1, the leader received a yellow jersey with a number 1 and other members received white jerseys with numbers 2-8. In group 2, the leader received a yellow jersey with his/ her name while other members received a white jersey with his/ her name. In group 3, the leader received a yellow shirt, residents received red shirts, nurses blue shirts, and consultants white shirts. In the control group, everyone wore plain clothes. Each group underwent 8 simulated CA/RR cases, with subjects taking turns leading each scenario. The number of directed commands (using name or number) vs. air commands (e.g. someone give epi) was recorded. Time to carry out each command and the percentage of commands carried out were also recorded. Time to initiation of clinical actions (ventilation, chest compressions, delivery of shock, administration of correct medication) was recorded. Results: In the 64 cases, there was a total of 2069 commands (32 per case on average). The percentage of directed commands vs. air commands was higher in the number jersey group vs. control group and in the named jersey group vs. the control group (18.9 vs. 7.6, p<0.01 and 24.2 vs. 7.6, p<0.01, respectively). The percentage of commands not carried out was similar between the named, numbered, and control groups, however it was higher in the colored jersey group vs. control group (15.1 vs. 7.9, p<0.01). The named jersey group was faster to initiate chest compressions and administer shocks than the control group (17.8s vs. 30.8s, p<0.01 and 279.2s vs. 334.2s, p<0.01). There was no significant difference for average time to perform other clinical actions between the four groups. Conclusions: The use of identifying jerseys was associated with an increased percentage of directed commands. Only named jerseys were associated with a decrease in time to initiation of compressions and administration of shock. Research is needed to assess the impact of identifying jerseys on performance during actual CA/ RR events.