Appendix S1-IHCA Participation Survey

Introductory page Dear __________, We are conducting a research study evaluating provider experiences caring for adult patients suffering an in- hospital cardiac arrest. We appreciate your completing the following brief survey. Study results will guide future projects to improve cardiac arrest resuscitation quality and patient outcomes after cardiac arrest. Your responses will not be linked to identifying information about you. Sincerely, Ithan Peltan, MD, MSc Cardiac arrest response involvement 1. Do you participate (or expect to participate) in the response to a cardiac arrest (a “Code Yes No Blue”) at an Intermountain Healthcare hospital at least once every 24 months? Only consider cardiac arrests of adult patients Alta View American Fork Bear River Valley Hospital Cassia Regional Medical Center Cedar City (Valley View) Hospital Delta Community Hospital Dixie Regional Medical Center Fillmore Community Hospital Garfield Memorial Hospital Heber Valley Medical Center 2. Select the one hospital where you are most Intermountain Medical Center likely to participate in cardiac arrest responses LDS Hospital Logan Regional Hospital McKay-Dee Hospital Orem Community Hospital Park City Medical Center Primary Children’s Hospital Riverton Hospital Sanpete Valley Hospital Sevier Valley Hospital The Orthopedic Specialty Hospital (TOSH) Utah Valley Regional Medical Center £ Inpatient medical or surgical ward £ ICU £ ED £ OR 3. Select all hospital settings where you might £ PACU participate in a cardiac arrest response. £ Obstetric ward/labor & delivery £ Cardiac catheterization lab (“cath lab”) £ Other procedural area (i.e. interventional radiology) £ Other hospital area (i.e. lab, cafeteria, radiology, outpatient clinic) Select all that apply Inpatient medical or surgical ward ICU ED 4. Select the one hospital setting where you are OR most likely to participate in a cardiac arrest PACU response. Obstetric ward/labor & delivery Cardiac catheterization lab (“cath lab”) Other procedural area (i.e. interventional radiology) Other hospital area (i.e. lab, cafeteria, radiology, outpatient clinic) * Question asked only of physicians † Question asked only of nurses ** Question is asked only of clinicians who indicate that they may play a leadership role on the Code Blue team ‡ Question asked only of physicians who indicate that they may play a leadership role on the Code Blue team §§ Question asked only of attending physician Cardiac arrest response role £ Team leader £ Informal assistant to code team leader* £ Formal assistant to code team leader* £ Nurse leader† £ Recorder† £ Perform chest compressions 5. When participating in a cardiac arrest £ Administer medications response, what are all the roles you might be £ Prepare medications called upon to perform? £ Manage ventilation, bag/mask £ Perform intubation £ Perform other invasive procedures (i.e. central line placement)* £ Draw labs £ Surgeon during OR code* £ Other/role task Select all that apply Team leader Informal assistant to code team leader* Formal assistant to code team leader* Nurse leader† Recorder† 6. When participating in a cardiac arrest Perform chest compressions Administer medications response, what one role would you be most Prepare medications likely to perform? Manage ventilation, bag/mask Perform intubation Perform other invasive procedures (i.e. central line placement)* Draw labs Surgeon during OR code* Other/role task * Question asked only of physicians † Question asked only of nurses ** Question is asked only of clinicians who indicate that they may play a leadership role on the Code Blue team ‡ Question asked only of physicians who indicate that they may play a leadership role on the Code Blue team §§ Question asked only of attending physician Cardiac arrest response experience 12 times In the past 12 months, how many times did you… 0 times 1-2 times 3-6 times 7-11 times or more 7. Participate in an adult cardiac arrest resuscitation? 8. Lead an adult cardiac arrest resuscitation?** Neither Consider all possible roles and hospital environments you indicated above Strongly Agree nor Strongly when answering the following questions. Disagree Disagree Disagree Agree Agree 9. I feel confident leading cardiac arrest resuscitations** 10. I feel confident participating in cardiac arrest resuscitations 11. I feel my resuscitation team(s) have the skills and knowledge needed to respond to cardiac arrest events effectively 12. I have difficulty thinking clearly during cardiac arrest resuscitations 13. My resuscitation team(s) have difficulty working together effectively or smoothly 14. I worry that I will make errors during cardiac arrest resuscitations 15. I worry that my resuscitation team(s) will make errors during cardiac arrest resuscitations 16. If I lead a cardiac arrest resuscitation on a weekday, at least one other physician will be present to provide assistance‡ 17. If I lead a cardiac arrest resuscitation on a night or on a weekend, at least one other physician will be present to provide assistance‡ * Question asked only of physicians † Question asked only of nurses ** Question is asked only of clinicians who indicate that they may play a leadership role on the Code Blue team ‡ Question asked only of physicians who indicate that they may play a leadership role on the Code Blue team §§ Question asked only of attending physician Demographics 18. What is your primary specialty?§§ Critical care (medical) Critical care (surgery/trauma) Critical care (anesthesia) Critical care (neurology) General surgery Hospitalist Internal medicine (outpatient & inpatient) Other medical subspecialty If you fit into >1 specialty category, choose the specialty Cardiothoracic surgery in which you are most likely to participate Other surgical subspecialty in a cardiac arrest resuscitation. Family medicine Emergency medicine Please choose "hospitalist" if you are a primary care Anesthesia physician who sees inpatients primarily while working as Obstetrics & gynecology a hospitalist (as opposed to also seeing outpatients at the Neurology same time) Other specialty 19. How old are you? † _____ 20. What percentage of your clinical time is spent caring for inpatients, ED patients, or 0% 50% 100% patients in hospital-based procedural or post-procedural areas (i.e. cath lab, OR, PACU)?* Click bar above and then drag to set response 21. How many years have you been a nurse?† _____ 22. Are you currently certified in ACLS Yes (advanced cardiac life support)? No 23. Have you participated in a cardiac arrest Yes simulation or “mock code” within the last No year? Answer "no" if the only cardiac arrest simulation you participated in was a "mega code" station during ACLS training. * Question asked only of physicians † Question asked only of nurses ** Question is asked only of clinicians who indicate that they may play a leadership role on the Code Blue team ‡ Question asked only of physicians who indicate that they may play a leadership role on the Code Blue team §§ Question asked only of attending physician Error text (incompatible unit reported) WAIT You selected “______” as the setting where you are most likely to participate in a cardiac arrest response, but you did not select "_______" as one of the settings where you might be part of the cardiac arrest team. Please reconcile your answers above before continuing. Error text (incompatible code team roles reported) WAIT You selected “______” as the role you are most likely to play in a cardiac arrest response, but you did not select "_______" as one of the roles you might play on the cardiac arrest team. Please reconcile your answers above before continuing. Error text (missing data) STOP You're almost done, but at least one required question in the ______ section still needs an answer. Completion text (ineligible provider due to lack of code participation or ineligible hospital/unit) Thank you! Based on your responses, you have provided all required information. Thank you for participating in this survey, _____. Please click the "Submit" button below to record your response and be entered to win an Amazon gift card. Completion text Thank you! Thank you for participating in this survey, ______. Please click the "Submit" button below to record your response and be entered to win an Amazon gift card. * Question asked only of physicians † Question asked only of nurses ** Question is asked only of clinicians who indicate that they may play a leadership role on the Code Blue team ‡ Question asked only of physicians who indicate that they may play a leadership role on the Code Blue team §§ Question asked only of attending physician .

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