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）是与患者预后不良相关的常见事件。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。虽然这被认为是通过采用改善IHCA护理流程的关键策略来解释的，但这些策略如何在日常实践中实际应用以及促成其成功实施的潜在因素在很大程度上仍然未知。此外，以前没有采取综合方法来检查在国际卫生保健行动期间使用的战略以及在这些事件前后使用的战略。这项研究将建立在我们的调查团队使用美国心脏协会的指南(GWTG)-复苏登记处的广泛前期工作的基础上，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研究将通过定义表现最好的医院采用的“最佳做法”来解决这些事件及其实施的潜在障碍，为IHCA今后的质量改进工作奠定基础。我们将使用顺序混合方法方法来实现这一目标，整合定量和定性分析。它的3个目标是：(1)在gwtg复苏登记处内确定预防和治疗IHCA表现最好的医院；(2)通过半结构化定性访谈，确定表现最好的网站的“最佳实践”；(3)在表现最好的地点验证与低IHCA发生率和高IHCA存活率相关的实践。研究结果将用于构建“最佳实践”工具包——蓝色代码包。在这项研究成功完成后，我们将与美国心脏协会（AHA）和gwtg复苏登记处密切合作，制定一项全国性的质量改进计划，以实施蓝色代码包。因此，HEROICA研究将提高NHLBI改善IHCA患者预后的能力，为医院提供切实可行的策略，可以广泛实施，以减少IHCA的发病率，提高IHCA的生存率。

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.