Variation in Post-Cardiac Arrest Care Within a Regional EMS System

Bosson, Nichole; Tolles, Juliana; Shavelle, David M.; Niemann, James T; Jue, Thomas; French, William J.; Gausche‐Hill, Marianne

doi:10.1080/10903127.2021.1965681

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…We previously conducted a retrospective cohort analysis of adults who had suffered an IHCA with ROSC over a 2‐year period at our hospital and observed substantial inconsistency in completing critical diagnostic and communication tasks in the immediate post‐ROSC setting 13 . Our results are consistent with studies that have shown variability in other post‐ROSC phases of care 14 . To address this, we hypothesized that the development and implementation of a post‐ROSC checklist would increase consistency in post‐ROSC clinical task completion at our institution.…”

Section: Introductionsupporting

confidence: 86%

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Checklists and consistency of care after resuscitation from in‐hospital cardiac arrest: A pilot study

Raikhel

Carlbom

Ferraro

et al. 2023

Journal of Hospital Medicine

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Background In‐hospital cardiac arrest (IHCA) with the return of spontaneous circulation (ROSC) is a clinical scenario associated with potentially devastating outcomes. Objective Inconsistencies in post‐ROSC care exist and we sought to find a low cost way to decrease this variability. Designs, Settings, and Participants We obtained pre and post intervention metrics including percentage of IHCA with a timely electrocardiogram (ECG), arterial blood gas (ABG), physician documentation, and documentation of patient surrogate communication after ROSC. Intervention We developed and implemented a post‐ROSC checklist for IHCA and measured post‐ROSC clinical care delivery metrics at our hospital during a 1‐year pilot period. Main Outcome and Results After the introduction of the checklist, 83.7% of IHCA had an ECG within 1 h of ROSC, compared to a baseline of 62.8% (p = 0.01). The rate of physician documentation within 6 h of ROSC was 74.4% after introduction of the checklist, compared to a baseline of 49.5% (p < 0.01). The percentage of IHCA with ROSC that completed all four of the critical post‐ROSC tasks after the introduction of the post‐ROSC checklist was 51.1% as compared to 19.4% before implementation (p < 0.01). Conclusions Our study demonstrated improved consistency in completing post‐ROSC clinical tasks after the introduction of a post‐ROSC checklist to our hospital. This work suggests that the implementation of a checklist can have meaningful impacts on task completion in the post‐ROSC setting. Despite this, considerable inconsistencies in post‐ROSC care persisted after the intervention indicating the limits of checklists in this setting. Future work is needed to identify interventions that can further improve post‐ROSC processes of care.

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Section: Introductionsupporting

confidence: 86%

“…13 Our results are consistent with studies that have shown variability in other post-ROSC phases of care. 14 To address this, we hypothesized that the development and implementation of a post-ROSC checklist would increase consistency in post-ROSC clinical task completion at our institution.…”

Section: Introductionmentioning

confidence: 99%

Checklists and consistency of care after resuscitation from in‐hospital cardiac arrest: A pilot study

Raikhel

Carlbom

Ferraro

et al. 2023

Journal of Hospital Medicine

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“…Guidelines exist in many countries to navigate appropriate prehospital care, yet there is substantial variability in adherence that is not fully explained by patient-specific factors. 81 82 83 84 85 86 87 88 89 Moreover, analyses of prehospital EMS protocols reveal failures of local practices to reflect evidence-based guidelines. 89 90 These studies emphasize a need for harmonization and education around prehospital management of patients with severe acute brain injury and DoC to promote equitable access to care.…”

Section: Hyperacute Phasementioning

confidence: 99%

Neuroethics across the Disorders of Consciousness Care Continuum

Young

Peterson

2022

Semin Neurol

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This review provides an ethical analysis of disorders of consciousness (DoC) along the care continuum, from preinjury to injury, acute care to subacute care and early rehabilitation, and finally transitioning to chronic rehabilitation and societal reintegration. We provide an actionable, chronological assessment of ethical issues related to DoC care. This expands upon established ethics literature, which focuses almost exclusively on the clinical encounter for DoC. Our goal is to broaden the aperture of ethical analysis to address how social and environmental conditions predispose some persons to brain injury, and how such conditions might also pose barriers to meaningful societal reintegration after recovery.

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