How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study.
How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study.
复制标题
DOI：
10.1161/circulationaha.118.033674
复制
发表时间：
2018-07-10
期刊：
影响因子：
37.8
通讯作者：
Chan PS
中科院分区：
文献类型：
--
作者：
Nallamothu BK;Guetterman TC;Harrod M;Kellenberg JE;Lehrich JL;Kronick SL;Krein SL;Iwashyna TJ;Saint S;Chan PS
院内心脏骤停（IHCA）很常见，美国各医院的结果差异很大，但这些差异的原因在很大程度上尚不清楚。我们开始更好地了解顶级医院如何组织他们的复苏团队，以实现高存活率的IHCA。我们计算了2012年至2014年美国心脏协会（AHA）Get-With-The-Guidelines®复苏登记医院的风险标准化IHCA生存率。我们确定了地理上和学术上多样化的医院在顶部，中间和底部的生存四分之一的IHCA和进行了定性研究，包括现场访问的临床和行政人员在9家医院的深入访谈。使用主题分析，数据进行了分析，以确定显着的主题知觉的性能由线人。在九家医院中，我们采访了来自多个学科的158名个人，包括医生（17.1%），护士（45.6%），其他临床工作人员（17.1%）和行政人员（20.3%）。我们确定了与复苏团队相关的四大主题：1）团队设计; 2）团队组成和角色; 3）IHCA期间的沟通和领导; 4）培训和教育。顶级医院的复苏团队表现出以下特点：专门或指定的复苏团队;在IHCA期间作为团队成员参与不同学科;团队成员的明确角色和责任;在IHCA期间更好的沟通和领导力;以及深入的模拟代码。在具有高IHCA存活率的医院中，复苏团队与非顶级医院不同。我们的研究结果表明，成功的复苏团队的核心要素，与更好的结果，并形成未来工作的基础，以改善IHCA。
In-hospital cardiac arrest (IHCA) is common and outcomes vary substantially across U.S. hospitals, but reasons for these differences are largely unknown. We set out to better understand how top-performing hospitals organize their resuscitation teams to achieve high survival rates for IHCA. We calculated risk-standardized IHCA survival to discharge rates across American Heart Association (AHA) Get-With-The-Guidelines® Resuscitation registry hospitals between 2012 and 2014. We identified geographically- and academically-diverse hospitals in the top, middle, and bottom quartiles of survival for IHCA and performed a qualitative study that included site visits with in-depth interviews of clinical and administrative staff at nine hospitals. Using thematic analysis, data were analyzed to identify salient themes of perceived performance by informants. Across nine hospitals, we interviewed 158 individuals from multiple disciplines including physicians (17.1%), nurses (45.6%), other clinical staff (17.1%), and administration (20.3%). We identified four broad themes related to resuscitation teams: 1) team design; 2) team composition and roles; 3) communication and leadership during IHCA; and 4) training and education. Resuscitation teams at top-performing hospitals demonstrated the following features: dedicated or designated resuscitation teams; participation of diverse disciplines as team members during IHCA; clear roles and responsibilities of team members; better communication and leadership during IHCA; and in-depth mock codes. Resuscitation teams at hospitals with high IHCA survival differ from non-top-performing hospitals. Our findings suggest core elements of successful resuscitation teams that are associated with better outcomes and form the basis for future work to improve IHCA.