Hospital Enhancement of Resuscitation Outcomes for In-Hospital Cardiac Arrest (HE

描述(由申请人提供)：院内心脏骤停(IHCA)是一种常见的事件，与不良的患者预后有关。然而，一些医院在预防和治疗IHCA方面一直比其他医院更成功。虽然这被认为是因为采取了改善国际人道主义援助护理程序的关键战略，但这些战略实际上是如何在日常实践中使用的，以及成功实施这些战略的根本因素在很大程度上仍不清楚。此外，以前没有采取综合办法来审查在国际人道主义援助评估期间使用的战略以及在这些活动之前和之后采用的战略。这项研究将建立在我们的研究团队使用美国心脏协会的GET With the Guidestions(GWTG)-复苏登记的广泛先前工作的基础上，并利用我们团队在IHCA和定性研究方面的专业知识。拟议的Heroica研究将为IHCA未来的质量改进工作奠定基础，通过定义一流医院为应对这些事件而采用的“最佳做法”以及实施这些事件的潜在障碍。我们将使用顺序混合方法来实现这一目标，将定量和定性分析结合起来。它的3个目标将：(1)在GWTG-复苏登记中确定在预防和治疗IHCA方面表现最好的医院；(2)通过半结构化定性访谈确定表现最好的地点的“最佳做法”；以及(3)验证与最佳地点的低IHCA发病率和高IHCA存活率相关的做法。这项研究的结果将被用来构建一个“最佳实践”的工具包--代码蓝色捆绑包。在这项研究成功完成后，我们将与美国心脏协会(AHA)和GWTG-复苏登记机构密切合作，制定一项全国性的质量改进计划，以实施代码蓝色捆绑。因此，Heroica研究将提高NHLBI的能力，通过为医院提供可广泛实施的实用和可操作的策略来降低IHCA的发生率和提高IHCA的存活率，从而改善IHCA患者的预后。

DESCRIPTION (provided by applicant): In-hospital cardiac arrest (IHCA) is a common event that is associated with poor patient outcomes. Yet, some hospitals have been consistently more successful in preventing and treating IHCA than others. While this is thought to be explained by the adoption of key strategies that improve care processes for IHCA, how these strategies are actually utilized in routine practice and the underlying factors contributing to their successful implementation remain largely unknown. Further, an integrative approach that examines strategies used during IHCA and those employed before and after these events has not been previously undertaken. This study will build on extensive prior work by our investigative team using the American Heart Association's Get With The Guidelines (GWTG)- Resuscitation registry and leverage our team's expertise in IHCA and qualitative research. The proposed HEROICA study will lay the foundation for future quality improvement efforts in IHCA by defining 'best practices' adopted by top-performing hospitals to address these events as well as potential barriers to their implementation. We will use a sequential mixed-methods approach to accomplish this goal, integrating quantitative and qualitative analyses. Its 3 Aims will: (1) identfy top- performing hospitals in preventing and treating IHCA within the GWTG-Resuscitation registry; (2) identify 'best practices' at the top-performing sites through semi-structured qualitative interviews; and (3) validate the practices associated with low IHCA incidence and high IHCA survival at top-performing sites. Findings from the study will be used to construct a toolkit of 'best practices' - the Code Blue Bundle. Upon successful completion of this research, we will partner closely with the American Heart Association (AHA) and the GWTG-Resuscitation registry to develop a national quality improvement program that will implement the Code Blue Bundle. Thus, the HEROICA study will increase the capacity of the NHLBI to improve outcomes for patients who suffer an IHCA by providing hospitals with practical and actionable strategies that can be implemented broadly to reduce the incidence and improve the survival of IHCA.