Departments of Internal Medicine (B.K.N., J.E.K., J.L.L., S.L. Krein, T.J.I., S.S.)
University of Michigan Medical School, Ann Arbor. Veterans Affairs Ann Arbor Center for Clinical Management Research, MI (B.K.N., S.L. Krein, T.J.I., S.S.).
Circulation. 2018 Jul 10;138(2):154-163. doi: 10.1161/CIRCULATIONAHA.118.033674.
In-hospital cardiac arrest (IHCA) is common, and outcomes vary substantially across US 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 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 9 hospitals. With the use of thematic analysis, data were analyzed to identify salient themes of perceived performance by informants.
Across 9 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 4 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.
院内心搏骤停（IHCA）很常见，美国各家医院的预后差异很大，但造成这种差异的原因尚不清楚。我们旨在更好地了解表现优异的医院如何组织其复苏团队，以实现 IHCA 高存活率。
我们计算了 2012 年至 2014 年期间在美国心脏协会 Get With The Guidelines-Resuscitation 注册医院中，按风险校正的 IHCA 存活至出院率。我们在地理和学术上均具有多样性的医院中，确定了 IHCA 存活率处于前四分之一、中位数和后四分之一的医院，并进行了一项定性研究，对 9 家医院的临床和行政人员进行了现场访问和深入访谈。通过主题分析，对数据进行分析以确定受访者认为的绩效突出主题。
在 9 家医院中，我们采访了来自多个学科的 158 人，包括医生（17.1%）、护士（45.6%）、其他临床人员（17.1%）和管理人员（20.3%）。我们确定了与复苏团队相关的 4 个广泛主题：（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。表现优异的医院的复苏团队具有以下特点：有专门或指定的复苏团队；在 IHCA 期间，不同学科的人员作为团队成员参与；团队成员的角色和职责明确；IHCA 期间的沟通和领导力更好；以及深入的模拟代码。
IHCA 存活率高的医院的复苏团队与表现不佳的医院不同。我们的研究结果表明，成功复苏团队的核心要素与更好的结果相关，并为未来改善 IHCA 的工作奠定了基础。
