Importance Although hospitals vary markedly in survival for their patients with in-hospital cardiac arrest, specific resuscitation practices that distinguish sites with higher cardiac arrest survival remain unknown. Objective To identify resuscitation practices associated with higher rates of in-hospital cardiac arrest survival. Design, Setting, and Participants Nationwide survey of resuscitation practices at adult hospitals participating in the Get With The Guidelines (GWTG)-Resuscitation registry and with ≥ 20 adult in-hospital cardiac arrest cases between 2012 and 2013. Main Outcomes and Measures Risk-standardized survival rates for cardiac arrest were calculated at each hospital, and these were then used to categorize hospitals into quintiles of performance. The association between resuscitation practices and quintiles of survival was evaluated using hierarchical proportional odds logistic regression models. Results Overall, 150 of 192 eligible hospitals (78.1%) completed the study survey and 131 facilities with ≥ 20 cases comprised the final study cohort. Risk-standardized survival rates after in-hospital cardiac arrest varied substantially (median: 23.7%; range: 9.2% to 37.5%). Several resuscitation practices were associated with survival on bivariate analysis, although only three were significant after multivariable adjustment: tracking interruptions in chest compressions (adjusted OR for being in a higher survival quintile category, 2.71 [95% CI: 1.24, 5.93]; P=0.01); reviewing cardiac arrest cases monthly or quarterly (adjusted OR for being in a higher survival quintile category, 8.55 [1.79, 40.0] for monthly and 6.85 [1.49, 31.3] for quarterly; P=0.03); and adequate resuscitation training (adjusted OR, 3.23 [1.21, 8.33]; P=0.02). Conclusions and Relevance Using survey information from acute care hospitals participating in a national quality improvement registry, we identified three resuscitation strategies associated with higher hospital rates of survival for patients with in-hospital cardiac arrest. These strategies can form the foundation for best practices for resuscitation care at hospitals, given the high incidence and variation in survival for in-hospital cardiac arrest.
Background: Substantial facility-level variation in survival exists following in-hospital cardiac arrest. Yet, specific resuscitation practices that distinguish hospitals with higher cardiac arrest survival remain unknown. Methods: We surveyed hospitals that submitted >20 adult in-hospital cardiac arrest cases to Get With The Guidelines (GWTG)-Resuscitation between 2012 and 2013 about resuscitation practices at their facility. We then used data from GWTG-Resuscitation to calculate risk-standardized rates for survival to discharge for each hospital, and categorized facilities into the top quintile, middle 2 to 4 quintiles, and bottom quintile based on their performance. The association between resuscitation practices and quintiles of survival was evaluated using hierarchical proportional odds logistic regression models. Results: Overall, 150 of 192 active adult hospitals (78.1%) facilities completed the study survey and 131 facilities with >20 cases comprised the final study cohort. Risk-standardized survival rates after in-hospital cardiac arrest varied substantially (median: 23.7%; range: 9.2%-37.5%). Several resuscitation practices were associated with survival on bivariate analysis, although only three were significant after multivariable adjustment: tracking interruptions in chest compressions (adjusted OR for being in a higher survival quintile category, 2.7 [95% CI: 1.2-5.9]; P=0.01); reviewing cardiac arrest cases monthly or quarterly (adjusted OR for being in a higher survival quintile category, 8.6 [1.8-40.0] for monthly and 6.9 [1.5-31.3] for quarterly; P=0.03); and inadequate resuscitation training (adjusted OR for at least a moderate barrier, 0.31 [0.12, 0.83]; P=0.02). Conclusion: Tracking interruptions in chest compressions, frequent review of cardiac arrest cases, and adequate resuscitation training are potentially key resuscitation practices associated with higher in-hospital cardiac arrest survival.
Background Although many hospitals have resuscitation champions, it is unknown if hospitals with very active physician or nonphysician champions have higher survival rates for in‐hospital cardiac arrest (IHCA). Methods and Results We surveyed adult hospitals in Get With The Guidelines‐Resuscitation about resuscitation practices, including about their resuscitation champion. Hospitals were categorized as having a very active physician champion, a very active nonphysician champion, or other (no champion or not very active champion). For each hospital, we calculated risk‐standardized survival rates for IHCA during the period of 2016 to 2018 and categorized them into quintiles of risk‐standardized survival rates. The association between a hospital's resuscitation champion type and their quintile of survival was evaluated using multivariable hierarchical proportional odds logistic regression. Overall, 192 hospitals (total of 44 477 IHCAs) comprised the study cohort. Risk‐standardized survival rates for IHCA varied widely between hospitals (median: 24.7%; range: 9.2%–37.5%). Very active physician champions were present in 29 (15.1%) hospitals, 64 (33.3%) had very active nonphysician champions, and 99 (51.6%) did not have a very active champion. Compared with sites without a very active resuscitation champion, hospitals with a very active physician champion were 4 times more likely to be in a higher survival quintile, even after adjusting for resuscitation practices across hospital groups (adjusted odds ratio [OR], 3.90; 95% CI, 1.39–10.95). In contrast, there was no difference in survival between sites without very active champions and those with very active non‐physician champions (adjusted OR, 1.28; 95% CI, 0.62–2.65). Conclusions The background and engagement level of a resuscitation champion is a critical factor in a hospital's survival outcomes for IHCA.
Interprofessional education (IPE) in health profession training is recognized as a key to improving patient care in practice settings. Though recognized as extremely important, implementation of IPE remains a challenge for many health profession programs. Despite challenges, the seven health profession (HP) programs at D'Youville College initiated IPE using healthcare simulation with professional actors serving as simulated patients. Faculty from chiropractic, dietetics, nursing, occupational therapy, pharmacy, physical therapy and physician assistant programs collaborated in this year-long implementation process. This manuscript provides a description of the planning, delivery and assessment of this innovative interprofessional simulation and the creation of the campus Interprofessional Clinical Advancement Center. Students reported enhanced understanding and respect of professional roles and responsibilities and ability to communicate effectively. Faculty reported an ability to encourage interaction and collaboration among HP students. Suggestions for curricular improvements and program sustainability included professional development and compensation. This manuscript should assist other health professional programs seeking guidance to implement and evaluate interprofessional education in academic institutions.
Purpose -Interprofessional education (IPE) is a method to create an environment that fosters interprofessional communication, understanding the roles and responsibilities of each profession, learning the skills to organize and communicate information for patients, families and members of the health care team. Providing IPE to health professional students can prepare them in the workforce to have the necessary skills to function in a collaborative practice ready environment. The purpose of this paper is to demonstrate the methods used in developing IPE curriculum, faculty training as debriefers/ facilitators, identify learning objectives and outcomes. Design/methodology/approach -The faculty and student surveys utilized a Likert scale. Learning objectives for the student survey assessed learning objective including communication of roles and responsibilities, communication and organization of information, engagement of other health professions (HP) in shared patient-centered problem solving, interprofessional assessment of patient status, and preparation of patients from transition of care to home. The faculty survey assessed faculty experience levels in IPE, role as facilitator/debriefer, and future needs for sustainability of the program.Findings -Student evaluation of IPE simulation experience revealed students believed they improved their interprofessional communication skills and had a better understanding of health professional roles and responsibilities. Faculty feedback indicated that HP students achieved learning objectives and their continued commitment to IPE however additional training and development were identified as areas of need. Practical implications -This paper can assist other educational institutions in developing IPE and structuring IPE assessment particularly in the HPs. Social implications -The public health care will be impacted positively by having health care providers specifically trained to work in teams and understand collaborative care. Student graduates in the HPs will be better prepared to function as a team in real clinical care following their participation in interprofessional simulation. Originality/value -This interprofessional simulation curriculum involves student learners from eight different HPs and participation of over 30 faculty from differing professions. This curriculum is unique in its bread and depth of collaboration and true teamwork across disciplines.
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