Best Practices for Education and Training of Resuscitation Teams for In-Hospital Cardiac Arrest

Abstract

Background: Survival outcomes following in-hospital cardiac arrest (IHCA) vary significantly across hospitals. Research suggests clinician education and training may play a role. We sought to identify best practices related to the education and training of resuscitation teams. Methods: We conducted a descriptive qualitative analysis of semi-structured interview data obtained from in-depth site visits conducted from 2016-2017 at 9 diverse hospitals within the American Heart Association "Get With The Guidelines" registry, selected based on IHCA survival performance (5 top-, 1 middle-, 3 low-performing). We assessed coded data related to education and training including systems learning, informal feedback and debrief, and formal learning through ACLS and mock codes. Thematic analysis was used to identify best practices. Results: In total, 129 interviews were conducted with a variety of hospital staff including nurses, chaplains, security guards, respiratory therapists, physicians, pharmacists, and administrators, yielding 78 hours and 29 minutes of interview time. Four themes related to training and education were identified: engagement, clear communication, consistency, and responsive leadership. Top-performing hospitals encouraged employee engagement with creative marketing of new programs and prioritizing hands-on learning over passive didactics. Clear communication was accomplished with debriefing, structured institutional review, and continual, frequent education for departments. Consistency was a cornerstone to culture change and was achieved with uniform policies for simulation practice as well as reinforced, routine practice (weekly, monthly, quarterly). Finally, top-performing hospitals had responsive leadership teams across multiple disciplines (nursing, respiratory therapy, pharmacy and medicine), who listened and adapted programs to fit the needs of their staff. Conclusions: Among top-performing hospitals excelling in IHCA survival, we identified core elements for education and training of resuscitation teams. Developing tools to expand these areas for hospitals may improve IHCA outcomes.

Data-driven resuscitation training using pose estimation

“…Devices that provide automated and objective CPR feedback can improve the quality of both CPR and the subsequent debrief sessions [ 5 , 14 – 19 ]. Because effective teamwork is vitally important during resuscitation [ 5 , 20 – 22 ], the assessment of resuscitation skills should include team interaction aspects [ 23 ].…”

Updating the model for Risk-Standardizing survival for In-Hospital cardiac arrest to facilitate hospital comparisons

“…This is important to emphasize since many research studies using GWTG-Resuscitation data are either focused on yearly trends in cardiac arrest survival or will include data from before and after the COVID-19 pandemic. Given that the initial RSSR model was used in prior GWTG-Resuscitation studies for in-hospital cardiac arrest, [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] our analyses provide reassurance that the updated RSSR model can be used in future research investigations that include cardiac arrest data from before 2020.…”

“… 2 This model has been used to facilitate hospital comparisons for annual benchmarking within the American Heart Association Get With The Guidelines ® (GWTG)-Resuscitation registry as well as for risk-adjustment in research investigations. [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] …”

The future of resuscitation education

“…An observational study recording videos of reallife in-hospital ALS resuscitation teams, demonstrated that teams with greater nontechnical skills also had better technical skills, including critical skills such as the quality of chest compressions, ventilation, rhythm control, and defibrillation [45 ▪▪ ]. Top performing in-hospital resuscitation teams prioritize hands-on learning, clear communication using debriefing, structured institutional reviews, and frequent education simulation with leadership across multiple disciplines [46 ▪▪ ].…”