Department of Internal Medicine (T.M.A., K.S., S.L. Krein, B.K.N., B.T.), University of Michigan Medical School, Ann Arbor.
Department of Internal Medicine, Veteran Affairs Ann Arbor Healthcare System, MI (R.S.).
Circ Cardiovasc Qual Outcomes. 2021 Dec;14(12):e008587. doi: 10.1161/CIRCOUTCOMES.121.008587. Epub 2021 Nov 15.
Survival outcomes following in-hospital cardiac arrest vary significantly across hospitals. Research suggests clinician education and training may play a role. We sought to identify best practices related to the education and training of resuscitation teams.
We conducted a descriptive qualitative analysis of semistructured interview data obtained from in-depth site visits conducted from 2016 to 2017 at 9 diverse hospitals within the American Heart Association "Get With The Guidelines" registry, selected based on in-hospital cardiac arrest survival performance (5 top-, 1 middle-, 3 low-performing). We assessed coded data related to education and training including systems learning, informal feedback and debrief, and formal learning through advanced cardiopulmonary life support and mock codes. Thematic analysis was used to identify best practices.
In total, 129 interviews were conducted with a variety of hospital staff including nurses, chaplains, security guards, respiratory therapists, physicians, pharmacists, and administrators, yielding 78 hours and 29 minutes of interview time. Four themes related to training and education were identified: engagement, clear communication, consistency, and responsive leadership. Top-performing hospitals encouraged employee engagement with creative marketing of new programs and prioritizing hands-on learning over passive didactics. Clear communication was accomplished with debriefing, structured institutional review, and continual, frequent education for departments. Consistency was a cornerstone to culture change and was achieved with uniform policies for simulation practice as well as reinforced, routine practice (weekly, monthly, quarterly). Finally, top-performing hospitals had responsive leadership teams across multiple disciplines (nursing, respiratory therapy, pharmacy and medicine), who listened and adapted programs to fit the needs of their staff.
Among top-performing hospitals excelling in in-hospital cardiac arrest survival, we identified core elements for education and training of resuscitation teams. Developing tools to expand these areas for hospitals may improve in-hospital cardiac arrest outcomes.
医院内心脏骤停后的生存结果在各医院之间差异显著。研究表明，临床医生的教育和培训可能发挥作用。我们试图确定与复苏团队教育和培训相关的最佳实践。
我们对 2016 年至 2017 年期间在美国心脏协会“遵循指南”注册中心内 9 家不同医院进行的深入现场访问中获得的半结构化访谈数据进行了描述性定性分析，这些医院是根据院内心脏骤停存活率（5 家顶尖、1 家中等、3 家低等）选择的。我们评估了与教育和培训相关的编码数据，包括系统学习、非正式反馈和讨论、以及通过高级心肺复苏和模拟代码进行的正式学习。使用主题分析来确定最佳实践。
共对包括护士、牧师、保安、呼吸治疗师、医生、药剂师和管理人员在内的各种医院工作人员进行了 129 次访谈，访谈时间总计 78 小时 29 分钟。确定了与培训和教育相关的四个主题：参与度、明确的沟通、一致性和响应式领导力。表现优异的医院鼓励员工参与，通过创新的新方案营销和优先考虑实践学习而不是被动教学。通过讨论、结构化机构审查和持续、频繁的部门教育来实现明确的沟通。一致性是文化变革的基石，通过模拟实践的统一政策以及强化、常规实践（每周、每月、每季度）来实现。最后，表现优异的医院在多个学科（护理、呼吸治疗、药学和医学）拥有响应式的领导团队，他们倾听并调整方案以满足员工的需求。
在院内心脏骤停存活率表现优异的顶尖医院中，我们确定了复苏团队教育和培训的核心要素。为医院开发扩展这些领域的工具可能会改善院内心脏骤停的结果。
