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Performance Improvement-Based Resuscitation Programme Reduces Arrest Incidence and Increases Survival from In-Hospital Cardiac arrest.
Resuscitation. 2015 Apr 20;
Authors: Davis DP, Graham PG, Husa RD, Lawrence B, Minokadeh A, Altieri K, Sell RE
Abstract
BACKGROUND: Traditional resuscitation training models are inadequate to achieving and maintaining resuscitation competency. This analysis evaluates the effectiveness of a novel, performance improvement-based inpatient resuscitation programme.
METHODS: This was a prospective, before-and-after study conducted in an urban, university-affiliated hospital system. All inpatient adult cardiac arrest victims without an active Do Not Attempt Resuscitation order from July 2005 to June 2012 were included. The Advanced Resuscitation Training (ART) programme was implemented in Spring 2007 and included a unique treatment algorithm constructed around the capabilities of our providers and resuscitation equipment, a training programme with flexible format and content including early recognition concepts, and a comprehensive approach to performance improvement feeding directly back into training. Our inpatient resuscitation registry and electronic patient care record were used to quantify arrest rates and survival-to-hospital discharge before and after ART programme implementation. Multiple logistic regression analysis was used to adjust for age, gender, location of arrest, initial rhythm, and time of day.
RESULTS: A total of 556 cardiac arrest victims were included (182 pre- and 374 post-ART). Arrest incidence decreased from 2.7 to 1.2 per 1,000 patient discharges in non-ICU inpatient units, with no change in ICU arrest rate. An increase in survival-to-hospital discharge from 21 to 45 percent (p<0.01) was observed following ART programme implementation. Adjusted odds ratios for survival-to-discharge (OR 2.2, 95% CI 1.4-3.4) and good neurological outcomes (OR 3.0, 95% CI 1.7-5.3) reflected similar improvements. Arrest-related deaths decreased from 2.1 to 0.5 deaths per 1,000 patient discharges in non-ICU areas and from 1.5 to 1.3 deaths per 1,000 patient discharges in ICU areas, and overall hospital mortality decreased from 2.2% to 1.8%.
CONCLUSIONS: Implementation of a novel, performance improvement-based inpatient resuscitation programme was associated with a decrease in the incidence of cardiac arrest and improved clinical outcomes.
PMID: 25906942 [PubMed - as supplied by publisher]