Department of Health Policy and Research, Weill Cornell Medicine, 402 East 67th St, LA-202, New York, NY, 10021, USA.
Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.
BMC Health Serv Res. 2020 Feb 27;20(1):145. doi: 10.1186/s12913-020-4990-4.
In-hospital cardiac arrests (IHCA) occur commonly and are associated with poor survival and variable outcomes. This study aimed to directly survey IHCA responders to understand their perceptions of resuscitation care.
As part of a quality improvement initiative, we surveyed participating providers of IHCAs at our institution from Jan 2014 to May 2016. The survey included unstructured free text feedback, which was the focus of this study. We systematically coded the free text and organized identifiable latent themes using thematic analysis. We used the natural timeline of an IHCA - pre-arrest, arrest, and post-arrest - for organization of the identifiable latent themes, and created a separate category for holistic remarks that arched across the timeline.
We identified 172 IHCAs with a mean of 1.7 responses per arrest (range: 1-8 responses). The mean age of this patient population was 59 years at the time of arrest, and 107 (62%) were men. We identified several themes - [1] issues around code activation and code status characterized the pre-arrest period [2] ,team interactions and issues around supplies/equipment dominated the intra-arrest period, and [3] code cessation and transitions of care typified the post-arrest period. Holistic remarks focused on attentiveness paid by the arrest team to patient comfort and family. Some comments reflected positive experiences but most focused on areas of improvement consistent with the initiative's purpose. In certain cases, we identified a tension between the need to balance established resuscitation protocols with flexibility required by real-life circumstances.
Directly surveying those who participated in IHCAs led to novel insights about their experiences. Our findings suggest that parsing through such qualitative feedback can help hospitals identify areas of improvement, modulate expectations, temper emotions, and refine protocols.
院内心搏骤停（IHCA）较为常见，与生存率低和预后多变相关。本研究旨在直接调查 IHCA 急救人员，以了解他们对复苏护理的看法。
作为一项质量改进计划的一部分，我们于 2014 年 1 月至 2016 年 5 月期间对我院参与 IHCA 的医护人员进行了调查。调查包括非结构化的自由文本反馈，这是本研究的重点。我们系统地对自由文本进行编码，并使用主题分析组织可识别的潜在主题。我们使用 IHCA 的自然时间线——发病前、发病时和发病后——来组织可识别的潜在主题，并创建了一个单独的类别来涵盖跨越时间线的整体意见。
我们确定了 172 例 IHCA，平均每例发病时有 1.7 次回复（范围：1-8 次）。该患者人群发病时的平均年龄为 59 岁，其中 107 例（62%）为男性。我们确定了几个主题——[1]发病前与代码激活和代码状态有关的问题；[2]发病时的团队互动和用品/设备问题；[3]发病后的代码停止和护理过渡。整体意见主要关注急救团队对患者舒适度和家属的关注。一些评论反映了积极的体验，但大多数都集中在与该计划目的一致的改进领域。在某些情况下，我们发现需要在既定复苏方案与现实情况所需的灵活性之间取得平衡。
直接调查参与 IHCA 的人员可以获得有关他们经验的新见解。我们的研究结果表明，对这种定性反馈进行梳理有助于医院确定改进领域，调节期望，缓解情绪，改进方案。
