Department of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USA.
Department of Internal Medicine, Division of Cardiovascular Medicine University of Michigan Medical School Ann Arbor Michigan USA.
J Am Heart Assoc. 2023 May 16;12(10):e027756. doi: 10.1161/JAHA.122.027756. Epub 2023 May 9.
Background Of the more than 250 000 emergency medical services-treated out-of-hospital cardiac arrests that occur each year in the United States, only about 8% survive to hospital discharge with good neurologic function. Treatment for out-of-hospital cardiac arrest involves a system of care that includes complex interactions among multiple stakeholders. Understanding the factors inhibiting optimal care is fundamental to improving outcomes. Methods and Results We conducted group interviews with emergency responders including 911 telecommunicators, law enforcement officers, firefighters, and transporting emergency medical services personnel (ie, emergency medical technicians and paramedics) who responded to the same out-of-hospital cardiac arrest incident. We used the American Heart Association System of Care as the framework for our analysis to identify themes and their contributory factors from these interviews. We identified 5 themes under the structure domain, which included workload, equipment, prehospital communication structure, education and competency, and patient attitudes. In the process domain, 5 themes were identified focusing on preparedness, field response and access to patient, on-scene logistics, background information acquisition, and clinical interventions. We identified 3 system themes including emergency responder culture; community support, education, and engagement; and stakeholder relationships. Three continuous quality improvement themes were identified, which included feedback provision, change management, and documentation. Conclusions We identified structure, process, system, and continuous quality improvement themes that may be leveraged to improve outcomes for out-of-hospital cardiac arrest. Interventions or programs amenable to rapid implementation include improving prearrival communication between agencies, appointing patient care and logistical leadership on-scene, interstakeholder team training, and providing more standardized feedback to all responder groups.
在美国，每年有超过 250000 例急救医疗服务处理的院外心搏骤停事件，仅有约 8%的患者能够存活并出院时具有良好的神经功能。院外心搏骤停的治疗涉及一个包含多个利益相关者之间复杂相互作用的护理系统。了解抑制最佳护理的因素是改善预后的基础。
我们对急救响应者（包括 911 调度员、执法人员、消防员和转运急救医疗服务人员（即急救医疗技术员和护理人员））进行了小组访谈，他们对同一例院外心搏骤停事件做出了响应。我们使用美国心脏协会的护理系统作为分析框架，从这些访谈中确定主题及其促成因素。我们在结构域下确定了 5 个主题，包括工作量、设备、院前通讯结构、教育和能力以及患者态度。在过程域中，确定了 5 个主题，重点关注准备、现场响应和获取患者、现场物流、背景信息获取和临床干预。我们确定了 3 个系统主题，包括急救响应者文化；社区支持、教育和参与；以及利益相关者关系。确定了 3 个持续质量改进主题，包括提供反馈、变更管理和文件记录。
我们确定了结构、过程、系统和持续质量改进主题，这些主题可能会被利用来改善院外心搏骤停的预后。易于快速实施的干预或计划包括改善机构之间的预到达通讯、在现场任命患者护理和物流领导、跨利益相关者团队培训以及向所有响应者群体提供更标准化的反馈。
