• Elizabeth A Hunt, Hillenn Cruz-Eng, Jamie Haggerty Bradshaw, Melanie Hodge, Tammi Bortner, Christie L Mulvey, Kristen N McMillan, Hannah Galvan, Jordan M Duval-Arnould, Kareen Jones, Nicole A Shilkofski, David L Rodgers, and Elizabeth H Sinz.
• Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
• Resuscitation. 2015 Jan 1;86:1-5.

BackgroundObservations of cardiopulmonary arrests (CPAs) reveal concerning patterns when clinicians identify a problem, (e.g. loss of pulse) but do not immediately initiate appropriate therapy (e.g. compressions) resulting in delays in life saving therapy.MethodsWe hypothesized that when individuals utilized specific, short, easy-to-state action phrases stating an observation followed by an associated intervention, there would be a higher likelihood that appropriate action would immediately occur. Phase I: A retrospective analysis of residents in simulated CPAs measured what proportion verbalized "There's no pulse", statements and/or actions that followed and whether "Action-Linked Phrases" were associated with faster initiation of compressions. Phase II: Two prospective, quasi-experimental studies evaluated if teaching three Action-Linked Phrases for Basic Life Support (BLS) courses or six Action-Linked Phrases for Advanced Cardiovascular Life Support (ACLS) courses was associated with increased use of these phrases.ResultsPhase I: 62% (42/68) of residents verbalized "there's no pulse" during initial assessment of a pulseless patient, and only 16/42 (38%) followed that by stating "start compressions". Residents verbalizing this Action-Linked Phrase started compressions sooner than others: (30s [IQR:19-42] vs. 150 [IQR:51-242], p < 0.001). Phase II: In BLS courses, the three Action-Linked Phrases were used more frequently in the intervention group: (226/270 [84%] vs. 14/195 [7%]; p < 0.001). In ACLS courses, the six Action-Linked Phrases were uttered more often in the intervention group: (43% [157/368] vs. 23% [46/201], p < 0.001).ConclusionsAction-Linked Phrases innately used by residents in simulated CPAs were associated with faster initiation of compressions. Action-Linked Phrases were verbalized more frequently if taught as part of a regular BLS or ACLS course. This simple, easy to teach, and easy to implement technique holds promise for impacting cardiac arrest teams' performance of key actions.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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