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: 10308731
• 负责人: BRAHMAJEE K NALLAMOTHU
• 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 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308731
• 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 evaluation; 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 起，改善院内心脏骤停 (IHCA) 护理 一直是退伍军人事务部的一个重要优先事项。在监察长办公室关于以下问题的报告之后，这一重点再次得到重视 2013 年 IHCA (13-00054-148)，并于 2015 年再次重复，形成 VHA 复苏质量 改进委员会 (RQI-C) 由负责临床操作的卫生部助理副部长组成。在 在个人层面上，退伍军人管理局临床医生投入了大量的时间来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。我们之前的 ResCU-1 项目确定了 VA 护理 IHCA 方面的关键差距：(1) 记录有助于系统的关键 IHCA 因素 推动质量改进，临床医生经常确定 IHCA 后的预后和治疗 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 以及 IHCA 后汇报。然而，ResCU-1 还发现 (3) 一些退伍军人从 IHCA 中恢复显着， 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：以 ResCU-1 为基础并与 VA 复苏教育机构合作 倡议（REdI），我们将： A1。评估新文档模板的实施情况作为模型 质量努力。 A2。开发和试点新的干预措施以改善 IHCA 护理，重点关注邮政编码 汇报、模拟代码模拟培训和代码文档。 A3。识别 IHCA 超级幸存者 & 与他们的护理相关的“最佳实践”。 项目方法：目标 1 将通过对所有 IHCA 住院情况进行回顾性审查来实现 电子病历、这些记录的研究辅助注释以及多级统计 造型。目标 2 将利用视频现场访问，利用既定框架来识别障碍和促进因素 （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）以改进文档、模拟代码和 IHCA 后汇报。目标 3 将进行深半 对超级幸存者、他们的非正式护理人员和具有类似残疾的对照患者进行结构化访谈 IHCA 后未康复的患者及其 VA 临床医生确定可能有助于 超级幸存者。这些做法与超级生存能力的关联将在以下方面进行测试： IHCA 幸存者的前瞻性队列。所有这些都将被整合起来，与合作伙伴一起制作和传播 “Code Blue Survivor Bundle”为进一步改善 IHCA 的 VA 护理奠定了基础。 对退伍军人医疗保健的预期影响：当患者心脏骤停时，会发生院内心脏骤停 由于电气或肌肉问题，有效地停止跳动。 IHCA 是一种医疗紧急情况； VA 投入大量资源来应对 IHCA。在 VA HSR&D 的 ResCU-1 研究中，我们发现 可以对许多患有 IHCA 的退伍军人的护理做出重大改进。在此提议的 ResCU 中 2 研究后，我们将与 VA 国家合作，努力改善这些基础设施。在目标 1 中，我们将评估 努力改进文件记录，并找出文件记录不足的地方。在目标 2 中，我们将 通过更好的文档、更好的实践和更好的方法来确定改善 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 还表明，一些 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能力。 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 整个 VA 提供如此优质护理的秘诀。