Cardiac Arrests in Skilled Nursing Facilities: Continuing Room for Improvement?

Shah, Manish N.; Fairbanks, Rollin J.; Lerner, E. Brooke

doi:10.1016/j.jamda.2005.11.009

Cited by 15 publications

(6 citation statements)

References 20 publications

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“…Shah et al proposed that a low incidence of witnesses to OHCA and a high incidence of pre-existing complications are the main reasons for this low survival rate [16]. In the present study, univariate analysis revealed that the incidence of prior disability was higher in care facilities than in other public facilities.…”

Section: Discussionmentioning

confidence: 42%

“…The likelihood of a return of spontaneous circulation and survival after an OHCA decreases with age [21,22], and we found the age of OHCA patients to be much higher in care facilities. Previous studies have reported incidences of witnessed OHCAs of 38–44% [16,23]. In our region, the incidence of witnessed OHCAs at care facilities (58.3%) was as high as that at other public facilities (55.6%).…”

Section: Discussionmentioning

confidence: 46%

“…Previous studies in the US have reported that OHCA patients in care facilities are frequently elderly males with a disability or illness and that the incidence of witnessed cardiac arrest ranges from 38% to 49% [15,16]. It has also been reported that the incidence of bystander CPR is higher in care facilities than in other public facilities [17].…”

Section: Discussionmentioning

confidence: 99%

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Misplaced links in the chain of survival due to an incorrect manual for the emergency call at public facilities

et al. 2013

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BackgroundThe incidence of delayed emergency calls and the outcome of out-of-hospital cardiac arrest (OHCA) may differ among public facilities when emergency calls are placed by institutional staff. The purpose of this study was to identify the actions prescribed in the rules and/or manuals of public facilities and to clarify whether the incidence of delayed emergency call placement and the outcome of OHCA differ among these facilities.MethodsWe performed a questionnaire-based survey regarding emergency calls in public facilities in our community and analyzed our regional Utstein-based OHCA database.ResultsOur questionnaire survey disclosed that the most common actions prescribed in the manuals or rules applied in care facilities and educational institutions are to report the situation when a cardiac arrest occurs and to follow the directions of a custodian or supervisor. The international web search disclosed that these actions are rarely prescribed in medical emergency manuals in other countries. Most of these manuals simply say that staff should make an emergency call immediately upon detecting a serious illness or medical emergency. Analysis of the Utstein-based database from our community revealed that the time interval between collapse and emergency call placement is prolonged and the outcome of cardiac arrest poor in care facilities. A prompt emergency call and cardiopulmonary resuscitation (CPR) after arrest are associated with improved 1-year survival following OHCA. Contrary to accepted wisdom, staff who recognize a cardiac arrest may consult their supervisor and then continue CPR until they receive instructions from him or her.ConclusionsManuals or rules for making emergency calls in our public facilities may contain incorrect information, and emergency calls may be delayed owing to correctable human factors. Such manuals should be checked and revised.

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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Misplaced links in the chain of survival due to an incorrect manual for the emergency call at public facilities

et al. 2013

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“… CPR in long-term care facilities. In 10 studies of LTC residents, survival to hospital discharge after CPR ranged from 0% to 2.9% [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. In three other studies, survival to hospital discharge was between 5% to 13% [ 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Goals of Care Conversations in Long-Term Care during the First Wave of the COVID-19 Pandemic

Mallery

Shetty

Moorhouse

et al. 2022

JCM

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Goals of care discussions typically focus on decision maker preference and underemphasize prognosis and outcomes related to frailty, resulting in poorly informed decisions. Our objective was to determine whether navigated care planning with nursing home residents or their decision makers changed care plans during the first wave of the COVID-19 pandemic. The MED-LTC virtual consultation service, led by internal medicine specialists, conducted care planning conversations that balanced information-giving/physician guidance with resident autonomy. Consultation included (1) the assessment of co-morbidities, frailty, health trajectory, and capacity; (2) in-depth discussion with decision makers about health status and expected outcomes; and (3) co-development of a care plan. Non-parametric tests and logistic regression determined the significance and factors associated with a change in care plan. Sixty-three residents received virtual consultations to review care goals. Consultation resulted in less aggressive care decisions for 52 residents (83%), while 10 (16%) remained the same. One resident escalated their care plan after a mistaken diagnosis of dementia was corrected. Pre-consultation, 50 residents would have accepted intubation compared to 9 post-consultation. The de-escalation of care plans was associated with dementia, COVID-19 positive status, and advanced frailty. We conclude that during the COVID-19 pandemic, a specialist-led consultation service for frail nursing home residents significantly influenced decisions towards less aggressive care.

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“…Patients who are older and have multiple coexisting illnesses have lower CPR survival rates (Ehlenbach et al., 2009; Hirlekar et al., 2018). Among nursing facility residents, CPR survival rates are very low, with estimates in the range of 1.5%–2.0% (Pape et al., 2018; Shah, Fairbanks, & Lerner, 2007). In addition, CPR is an invasive procedure necessitating transfer to the hospital and the use of mechanical ventilation and intubation.…”

Section: Introductionmentioning

confidence: 99%

Nursing facility residents’ cardiopulmonary resuscitation decisions

Matthias

2020

Int J Older People Nursing

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Context: As many as one-quarter of all residents in nursing facilities have cardiopulmonary resuscitation (CPR) as a documented choice in the medical record, despite the likelihood of limited medical benefit in this setting. Objectives: The aim of this study was to understand the perspectives of healthcare providers and nursing facility residents regarding CPR decisions. Methods: We used qualitative interviews to examine the perspectives of residents with a documented decision for CPR in the medical record. We then compared residents' views with those of healthcare providers who routinely conduct advance care planning (ACP) conversations in the nursing facility setting. Results: Five themes emerged from the interviews: (a) Resident versus Provider Concerns, (b) Offering Information versus Avoidance, (c) Lack of Understanding of CPR, (d) Lack of Awareness, and (e) 'Don't Keep Me on Machines'. Residents held misconceptions about CPR and/or exhibited an overall poor understanding of the relationship between their own health status and the likelihood of a successful CPR attempt. Although healthcare providers offer information and health education in an attempt to address knowledge gaps, these efforts are not always successful or even accepted by residents. Resident viewpoints and priorities differed from healthcare providers in ways that affected communication about CPR. Conclusions: Unrecognised differences in perceptions between providers and residents affect key aspects of ACP communication that can impact CPR decision-making. The concerns and priorities of institutionalized older adults may differ from those of healthcare providers, creating challenges for engaging some residents in ACP. Implications for Practice: ACP communication models and training should be designed not only to explore nursing facility residents' goals, values, and preferences, but also to elicit any underlying differences in perceptions that may affect communication. Healthcare providers can identifying the primary concerns of residents and assist them with integrating or reframing these issues as a part of ACP discussions.

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Cardiac Arrests in Skilled Nursing Facilities: Continuing Room for Improvement?

Cited by 15 publications

References 20 publications

Misplaced links in the chain of survival due to an incorrect manual for the emergency call at public facilities

Misplaced links in the chain of survival due to an incorrect manual for the emergency call at public facilities

Goals of Care Conversations in Long-Term Care during the First Wave of the COVID-19 Pandemic

Nursing facility residents’ cardiopulmonary resuscitation decisions

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