ResCU II: Improving In-hospital Cardiac Arrest Care and Discovering Keys to Super-Survivorship

ResCU II：改善院内心脏骤停护理并发现超级幸存者的关键

• 批准号: 10308433
• 负责人: Theodore J Iwashyna
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308433
• 关键词: Address; Advanced Cardiac Life Support; Affect; Aftercare; Area; Back; Blood; Cardiology; Cardiopulmonary Resuscitation; Caregivers; Caring; Cessation of life; Characteristics; Clinical; Code; Code Blue; Computerized Medical Record; Consequentialism; Consolidated Framework for Implementation Research; Credentialing; Critical Care; Critical Illness; Data; Data Element; Discipline of Nursing; Documentation; E-learning; Education; Evaluation; Event; Failure; Foundations; Funding; Gerontology; Health; Healthcare; Heart; Heart Arrest; Hospitalization; Hospitals; Incidence; Individual; Intervention; Interview; Investments; Knowledge; Label; Lead; Leadership; Learning; Literature; Medical emergency; Methods; Modeling; Muscle; National Heart, Lung, and Blood Institute; Patient Care; Patients; Plant Roots; Posttraumatic growth; Process; Prognosis; Prospective cohort; Qualitative Research; Records; Recovery; Recovery of Function; Reporting; Research; Research Assistant; Resources; Resuscitation; Running; Sampling; Site Visit; Standardization; Statistical Models; Stress; Structure; Surveillance Methods; Surveys; Survivors; System; Testing; Theoretical Domains framework; Time; Training; Training Support; Trauma; Variant; Veterans; Work; base; beneficiary; clinical epidemiology; disability; efficacy evaluation; experience; hospital performance; implementation intervention; implementation science; improved; informal caregiver; multidisciplinary; operation; response; simulation; survivorship; therapy design; tool

Project Background: Since at least VHA Directive 2008-063, improving in-hospital cardiac arrest (IHCA) care has been an important VA priority. This focus was renewed after the Office of the Inspector General report on IHCA in 2013 (13-00054-148), and repeated again in 2015 with the formation of VHA Resuscitation Quality Improvement Committee (RQI-C) by Assistant Deputy Undersecretary for Health for Clinical Operations. At the individual level, vast amounts of VA clinician time are devoted to having every clinician recertify their Basic or Advanced Cardiac Life Support training every two years to improve the care of IHCA. Our previous ResCU-1 project identified critical gaps in VA care of IHCA: (1) documentation of key IHCA factors that help systems drive quality improvement, and clinicians determine prognosis and treatment after IHCA were often unavailable; (2) 1/3rd to 2/3rd of VA hospitals underutilized other best practices in IHCA care, e.g. mock codes and post-IHCA debriefing. Yet, ResCU-1 also found (3) some Veterans had remarkable recovery from IHCA, becoming “super-survivors”—but we do not know how the care of super-survivors differed. Specific Aims: Building on ResCU-1's foundations and in partnership with the VA Resuscitation Education Initiative (REdI), we will: A1. Assess implementation of a new documentation template as a model for quality efforts. A2. Develop & pilot new interventions to improve IHCA care, focusing on post-code debriefing, mock code simulation training, and code documentation. A3. Identify IHCA super-survivors & `best practices' associated with their care. Project Methods: Aim 1 will be accomplished by retrospective review of all IHCA hospitalizations' electronic medical records, research-assistant annotation of those records, and multi-level statistical modeling. Aim 2 will use video-site-visits to identify barriers and facilitators using established frameworks (CFIR and TDF), and then partner to pilot and implement interventions (likely beginning with virtual learning collaborative) to improve documentation, mock codes, and post-IHCA debriefing. Aim 3 will do deep semi- structured interviews with super-survivors, their informal caregivers and control patients of similar disability who did not recover after IHCA, and their VA clinicians to identify candidate practices that may contribute to super-survivorship. The association of those practices with super-survivorship will then be tested in a prospective cohort of IHCA survivors. All will be integrated to produce and disseminate with partners a `Code Blue Survivor Bundle' to form the basis of further improvements in VA care of IHCA. Anticipated Impact on Veteran's Healthcare: An in-hospital cardiac arrest occurs when a patient's heart stops beating effectively, either due to electrical or muscular problems. IHCA is a medical emergency; VA devotes great resources to responding to IHCAs. In VA HSR&D's ResCU-1 study, we discovered that important improvements can be made to the care of many Veterans who suffer IHCA. In this proposed ResCU- 2 study, we will partner with VA national efforts to improve these fundamentals. In Aim 1, we will evaluate efforts to improve documentation, and identify where documentation remains inadequate. In Aim 2, we will identify barriers and facilitators to improving IHCA care via better documentation, better practice and better post-IHCA debriefing—and design interventions to improve their use. But ResCU-1 also showed that a few Veterans go on from IHCA to become super-survivors, showing remarkable recovery after their cardiac arrest. In Aim 3, we will use mixed methods to discover practices that lead to super-survivorship, and disseminate the secrets to such excellent care throughout VA.

项目背景：至少自VHA指令2008 - 063以来，改善院内心脏骤停（IHCA）护理 一直是退伍军人事务部的重要任务在监察主任办公室报告 2013年的IHCA（13 - 00054 - 148），2015年再次重复，形成VHA复苏质量 改进委员会（RQI-C）由负责临床业务的卫生部助理副部长组成。在 在个人水平上，VA临床医生投入大量时间，让每位临床医生重新认证他们的基本或 每两年进行一次高级心脏生命支持培训，以改善IHCA的护理。我们以前的ResCU-1 项目确定了IHCA VA护理的关键差距：（1）记录有助于系统的关键IHCA因素 推动质量改进，临床医生在IHCA后确定预后和治疗， 不可用;（2）1/3至2/3的VA医院未充分利用IHCA护理中的其他最佳实践，例如模拟代码 和国际人道主义援助后的汇报然而，ResCU-1还发现（3）一些退伍军人从IHCA中恢复得很好， 成为"超级幸存者"，但我们不知道超级幸存者的护理有何不同。 具体目标：建立在ResCU-1的基础上，并与VA复苏教育合作 倡议（REdI），我们将：A1。评估新文件模板的实施情况，作为 质量努力。A2.制定和试点新的干预措施，以改善IHCA护理，重点是邮政编码 任务报告、模拟代码模拟培训和代码文档。A3.识别IHCA超级幸存者& 与照顾儿童有关的"最佳做法"。 项目方法：目标1将通过对所有IHCA住院患者的回顾性分析来实现。 电子医疗记录，这些记录的研究辅助注释，以及多层次统计 建模目标2将使用视频现场访问，利用既定框架确定障碍和促进因素 (CFIR和TDF），然后合作试点和实施干预措施（可能从虚拟学习开始 协作），以改进文件、模拟代码和IHCA后的汇报。目标3将做深半- 对超级幸存者、他们的非正式照顾者和类似残疾的对照患者进行结构化访谈 在IHCA后没有恢复的患者，以及他们的VA临床医生，以确定可能有助于 超级幸存者这些做法与超级幸存者的联系将在一个 IHCA幸存者的前瞻性队列。所有这些都将被整合，以便与合作伙伴一起制作和传播， "Code Blue Survivor Bundle"，作为进一步改善IHCA退伍军人护理的基础。 对退伍军人医疗保健的预期影响：当患者的心脏 停止有效地跳动，无论是由于电气或肌肉问题。IHCA是一种医疗紧急情况; VA 投入大量资源应对IHCA。在VA HSR & D的ResCU-1研究中，我们发现， 可以对许多患有IHCA的退伍军人的护理进行重要的改进。在这一提议中， 2研究，我们将与弗吉尼亚州的国家努力，以改善这些基本面的合作伙伴。在目标1中，我们将评估 努力改进文件，并查明文件仍有不足之处。在目标2中，我们将 通过更好的文件、更好的实践和更好的方法，确定改善IHCA护理的障碍和促进因素。 IHCA后汇报-并设计干预措施以改善其使用。但ResCU-1也表明， 退伍军人从IHCA继续成为超级幸存者，在心脏骤停后表现出显着的恢复。 在目标3中，我们将使用混合方法来发现导致超级生存的实践，并传播 在整个VA中获得如此出色的护理。