St. Mark

St. Mark's Hospital


By adopting HearthCode® and megacode simulations, St. Mark's has been able to:
Decrease learner classroom time for Advanced Cardiac Life Support (ACLS) by eight hours, plus two hours in the skills lab

  • Decrease ACLS instructor hours by eight hours
  • Improve unit performance and communication practices during code situations
  • Build a stronger learner-focused environment to ensure that learners are more prepared when they start ACLS
  • Continuously improve staff preparation for life threatening emergencies through regular ACLS practice and skill measurement


St. Mark’s Hospital is a 317-bed hospital that includes an acute care ER, rehabilitation unit, and a Level III Trauma Center. Continually recognized for its high-quality performance, being recognized as “One of 50 Top Cardiovascular Hospitals” in the nation by Thomas Reuters, it strives to provide care for patients in harmony with a long tradition of quality and compassion. In keeping with this mission, St. Mark’s Hospital is focused on improving the quality of care delivered to its patients and does so by adopting training programs like HeartCode.

While education leaders at St. Mark’s Hospital were pleased with the content of the American Heart Association (AHA) ACLS courses offered via classroom instruction, they recognized that there were opportunities to improve. Instructors were inconsistent in their teaching and evaluation practices. Additionally, the hospital’s equipment was old and did not have the ability to provide feedback or measure performance. As a result, staff mastery of the required skills was inconsistent. Staff members were not fully prepared, and they had poor communication skills on the floor during codes.

Staff had lost touch with various skills, such as using defibrillators and crash carts. Moreover, there was an established culture in which some staff members barely met the requirements to earn their completion cards. It was clear that St. Mark’s needed a stronger learning program that offered more realistic experience when it came to practicing and reinforcing first-responder actions.


St. Mark’s Hospital educators decided to combine HeartCode ACLS with simulation-based training. Now, students first complete their HealthStream Learning Center (HLC) assignment for HeartCode ACLS Part 1, the cognitive learning module that leverages MicroSim technology to create realistic patient scenarios, giving the learner the opportunity to apply and master the AHA 2010 guidelines for CPR & ECC. Then students use the HLC to register for a megacode simulation with skills practice and testing. Students are emailed learning expectations prior to the course so they know what to expect. In order to pass, learners must score 90 percent on the rhythm recognition quiz, demonstrate a hands-on full defibrillation competency, participate in a megacode, and lead the code team through a megacode. During the megacode simulation, instructors use both pre-programmed and on-the-fly scenarios. Simulation-based training sessions take place two-to-three times a month. Five students can use the manikin per session. Each session offers three manikins and a crash cart.

The hospital offers an annual mock code to test ACLS skills. This involves an ACLS instructor presenting a mock code along with a practice in which each learner must perform as a team leader in a megacode. Additionally, impromptu monthly mock codes are held, to which nurses and other staff working on the hospital floor are required to respond.

The hospital has made other improvements as well, such as providing a special HeartCode instructor site to track students and coursework. Learner classes and training are held in a central location in special HeartCode rooms and simulation rooms. Additionally, simulation-based training is fully integrated into new nurse orientation.

While we have had a lot of fun with the program, one of the most important things it did was help foster staff accountability, which is a major accomplishment. Now, staff members are better prepared.
— Jennifer Teerlink, Director of Education


Today, learners are more prepared when they start ACLS, and by regularly practicing and measuring skills, they are able to continue to improve. This is apparent on the units, where performance and communication practices have improved during code situations. Hospital instructors are also excited to offer the new course, which sets the stage for a stronger learner-focused environment. Learner classroom time decreased from 16 to 8 hours of HeartCode, plus 2-3 hours in the skills lab. Instructor hours have decreased from 16 hours to only teaching in the skills lab for 2-3 hours.

As expected, there was initial resistance. This was addressed by discussing the training program at department meetings. Also, teaching staff offered opportunities for nurses to practice on manikins on the floor and held contests and raffles to stimulate interest. Students are allowed to take courses outside of the hospital at their own expense, but over time, many have come around with some students even forming study groups to ensure skill mastery. They are grateful to receive the advanced training and are embracing the new process.

Now that HeartCode ACLS with megacode is a success, St. Mark’s Hospital hopes to incorporate videotaping into the program, automate more processes, and offer additional coursework through the HLC.

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