Mok Garrick, Vaillancourt Samuel, Fu Minnie, Gray Sara, Chartier Lucas B, Wong Natalie, Allan Katherine S, Warsi Farah, Callender Celine, McGowan Melissa, Petrosoniak Andrew
Department of Emergency Medicine, Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
CJEM. 2025 Mar 7. doi: 10.1007/s43678-025-00882-w.
We used quality improvement (QI) methodology to improve cardiopulmonary resuscitation (CPR) data collection within the emergency department (ED) for non-traumatic cardiac arrests. This novel program aimed to improve CPR data collection from a baseline of 48.7-80% between August 15th, 2023-April 14th, 2024.
The outcome measure was percentage of cases with CPR data available. The secondary measures included CPR rate and depth (composite measure), compression fraction, and CPR pauses < 10 s. Manual review of electronic health records and Zoll Case Review was utilized for data extraction. The project team was created utilizing a stakeholder matrix. Diagnostics included an Ishikawa diagram, QI huddles, simulation, and process mapping. Interventions included: introduction of an emergency medical services (EMS)-to-ED adapter, simulation and education, and data debriefing. Elements were introduced and tested with simulation prior to implementation. P-charts and x-charts were used to determine successful completion of aims.
CPR data were available in 48.7% (19/39) of cardiac arrest cases during the baseline period (February 15th, 2023-August 14th, 2023). Special cause variation was met during the implementation period with a shift (≥ 8 consecutive points above or below median), improving data collection to 89.1% (49/55). Improvements were identified with a shift for CPR in target for rate and depth (1.8-20.4%) and compression fraction (82.2-86.9%). No special cause variation was identified for CPR pauses < 10 s.
Through the use of QI methodology, we successfully improved CPR data collection within our ED from 48.7-89.1% for non-traumatic cardiac arrests. Improvements were seen in CPR in target for rate and depth, and compression fraction. This program provides a foundation for reliable CPR performance measurement and improvement, and serves as an example for other ED's with similar interest in CPR performance improvement.
我们采用质量改进（QI）方法，以改善急诊科（ED）内非创伤性心脏骤停的心肺复苏（CPR）数据收集情况。这个新项目旨在将2023年8月15日至2024年4月14日期间CPR数据收集的基线水平从48.7% - 80%提高。
结果指标是有CPR数据的病例百分比。次要指标包括CPR速率和深度（综合指标）、按压比例以及CPR中断时间<10秒。通过人工查阅电子健康记录和Zoll病例回顾进行数据提取。利用利益相关者矩阵组建项目团队。诊断方法包括石川图、QI小组讨论、模拟和流程映射。干预措施包括：引入紧急医疗服务（EMS）到ED的转接器、模拟和教育以及数据汇报。在实施之前，通过模拟对各项要素进行了引入和测试。使用P图和x图来确定目标的成功达成。
在基线期（2023年2月15日至2023年8月14日），48.7%（19/39）的心脏骤停病例有CPR数据。在实施期间出现了特殊原因变异（连续8个点及以上高于或低于中位数），数据收集率提高到了89.1%（49/55）。在CPR速率和深度目标（1.8% - 20.4%）以及按压比例（82.2% - 86.9%）方面出现了改善。对于CPR中断时间<10秒，未发现特殊原因变异。
通过使用QI方法，我们成功地将急诊科内非创伤性心脏骤停的CPR数据收集率从48.7%提高到了89.1%。在CPR速率和深度目标以及按压比例方面都有改善。该项目为可靠的CPR性能测量和改进奠定了基础，并为其他对CPR性能改进有类似兴趣的急诊科提供了范例。
