Abstract Rationale In-hospital cardiac arrests (IHCA) outside the ICU are common and highly lethal. Leadership and team organization influence performance, yet the effect of adding a Pulmonary and Critical Care Medicine (PCCM) fellow to codes led by Internal Medicine residents (IMR) is unknown. We evaluated whether routinely including a PCCM fellow during daytime IHCA affects team perceptions and patient outcomes. Methods On 3/4/2025, our institution implemented a protocol for a PCCM fellow to attend all daytime IHCA outside the ICU as consultant to the IMR leader. Baseline (2/26–3/4/2025) and follow-up (6/12–6/30/2025) surveys were administered to IMR, other code-team members (nurses, supervisors, pharmacists), and PCCM fellows. Instruments assessed self-efficacy, organization, communication, preparedness, and perceived fellow impact (ordinal scales with optional free text). Non-probability sampling targeted all eligible personnel. Group-level comparisons used Wilcoxon–Mann–Whitney tests (α = 0.05). Daytime IHCA outcomes pre vs post—ROSC and survival to discharge—were compared with exact tests. Results Residents: 35/135 (25.9%) baseline and 54/135 (40.0%) follow-up responses. No domain changed significantly; perceived benefit of a fellow trended higher (mean 2.0±1.2 to 4.0±0.9; P = 0.096). Comments cited cognitive support (H’s/T’s), procedures, POCUS, and ICU transfer facilitation; a minority expressed concern about potential role overreach.Code team: 69/78 (88.5%) baseline and 36/78 (46.2%) follow-up responses. Organization improved significantly (2.5±0.6 to 3.1±0.4; P = 0.01). Preparedness trended higher (2.4±0.6 to 2.9±0.7; P = 0.08). Free-text highlighted added ICU expertise, a calmer “bird’s-eye” presence, and help maintaining role clarity; a minority noted possible role confusion.Fellows: 9/10 (90%) baseline and 8/10 (80%) follow-up responses. Most reported 0–3 study-hospital codes during each window. Two domains trended down: satisfaction with exposure (3.0±1.0 to 1.6±0.6; P = 0.08) and comfort with procedures (3.6±0.5 to 2.7±0.6; P = 0.07).IHCA outcomes: Daytime arrests pre n = 7, post n = 8. ROSC 71% vs 75% (P = 0.66); survival to discharge 71% vs 50% (P = 0.38). Conclusions Routine inclusion of a PCCM fellow during daytime IHCA was associated with significantly better perceived organization and a trend toward improved preparedness, without evidence of harm to resident leadership or team function. Objective outcomes did not differ, likely reflecting few events over a short interval. Qualitative feedback suggests fellows provide cognitive offloading, procedural capability, and calmer coordination. Larger, longer evaluations are warranted to estimate effects on patient outcomes and refine role definitions that preserve trainee autonomy. This abstract is funded by: None
Anderson-Bell et al. (Fri,) studied this question.