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Center for Life Support Education, Greater Charlotte Market

Presentation Notes

Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.

Abstract

Background: Over 290,000 in-hospital cardiac arrests occur annually in the United States. Survival is about 25% with significant variation across the country.1,2 High-quality chest compressions are a vital factor to achieving return of spontaneous circulation and improving outcomes after a cardiac arrest.3,4 Research illustrates a propensity for healthcare professionals to provide chest compressions at a rate outside the recommended guidelines.2,5

Local Problem: Baseline data for rate compliance in the study group was 15-64%.

Method: An interdisciplinary, interfacility team focused on optimizing care across the resuscitative care continuum utilized the Plan, Do, Study, Act methodology. The team assessed the impact of an awareness campaign on rate compliant chest compressions and their effect on return of spontaneous circulation. Minute by minute rate data from the Lifepak defibrillators in nine facilities in the Greater Charlotte Market was shared on a Power BI dashboard and communicated in quarterly cycles for 2023.

Results: Five out of nine facilities ended 2023 with improvement over the baseline data with two facilities exceeding the published benchmark of 80%. Compliance quartiles were calculated, and cases were sorted into two groups: Group 1 (compliance > 80%) or Group 2 (compliance < 32% (first quartile)). Sample size was determined by Cochran’s formula (95% CI), Group 1: 155 cases, sample size 111; Group 2: 147 cases, sample size 107. Group 1 achieved return of spontaneous circulation 20% more frequently than Group 2. Chi-squared test indicated confirmed significance of finding (p=0.0223).

Implications for practice: High-quality chest compressions are linked with increases in return of spontaneous circulation, survival, and survival with intact neurological outcome.2 The project creates no financial burden. The project’s collaborative approach leverages existing resources, engages stakeholders, and fosters ownership, facilitating greater buy in and sustainability of the improvements. This initiative can be leveraged across Advocate Health.

References

  1. Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA. 2019 Mar 26;321(12):1200-1210. Doi: 10.1001/jama.2019.1696. PMID: 30912843; PMCID: PMC6482460.
  2. Rideout, J. M., Ozawa, E. T., Bourgeois, D. J., Chipman, M., & Overly, F. L. (2021). Can hospital adult code-teams and individual members perform high-quality CPR? A multicenter simulation-based study incorporating an educational intervention with CPR feedback. Resuscitation plus, 7, 100126.
  3. Abella, B. S., Sandbo, N., Vassilatos, P., & Alvarado, J. P. (2005). Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal. Circulation, 111(Feb), 428-434. https://doi.org/10.1161/01.CIR.0000153811.84257.59
  4. Gugelmin-Almeida, D., Tobase, L., Polastri, T. F., Peres, H. H. C., & Timerman, S. (2021). Do automated real-time feedback devices improve CPR quality? A systematic review of literature. Resuscitation Plus, 6, 100108.
  5. Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., O'Neil, B. J., Peberdy, M. A., Rittenberger, J. C. (2020). Part 3: Adult basic and advanced life support: 2020 american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16_suppl_2). https://doi.org/10.1161/cir.0000000000000916

Document Type

Poster

Publication Date

11-13-2024

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Nov 13th, 12:00 AM

Effects of Compliant Chest Compression Rate on Return of Spontaneous Circulation in In-Hospital Cardiac Arrest

Background: Over 290,000 in-hospital cardiac arrests occur annually in the United States. Survival is about 25% with significant variation across the country.1,2 High-quality chest compressions are a vital factor to achieving return of spontaneous circulation and improving outcomes after a cardiac arrest.3,4 Research illustrates a propensity for healthcare professionals to provide chest compressions at a rate outside the recommended guidelines.2,5

Local Problem: Baseline data for rate compliance in the study group was 15-64%.

Method: An interdisciplinary, interfacility team focused on optimizing care across the resuscitative care continuum utilized the Plan, Do, Study, Act methodology. The team assessed the impact of an awareness campaign on rate compliant chest compressions and their effect on return of spontaneous circulation. Minute by minute rate data from the Lifepak defibrillators in nine facilities in the Greater Charlotte Market was shared on a Power BI dashboard and communicated in quarterly cycles for 2023.

Results: Five out of nine facilities ended 2023 with improvement over the baseline data with two facilities exceeding the published benchmark of 80%. Compliance quartiles were calculated, and cases were sorted into two groups: Group 1 (compliance > 80%) or Group 2 (compliance < 32% (first quartile)). Sample size was determined by Cochran’s formula (95% CI), Group 1: 155 cases, sample size 111; Group 2: 147 cases, sample size 107. Group 1 achieved return of spontaneous circulation 20% more frequently than Group 2. Chi-squared test indicated confirmed significance of finding (p=0.0223).

Implications for practice: High-quality chest compressions are linked with increases in return of spontaneous circulation, survival, and survival with intact neurological outcome.2 The project creates no financial burden. The project’s collaborative approach leverages existing resources, engages stakeholders, and fosters ownership, facilitating greater buy in and sustainability of the improvements. This initiative can be leveraged across Advocate Health.

References

  1. Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA. 2019 Mar 26;321(12):1200-1210. Doi: 10.1001/jama.2019.1696. PMID: 30912843; PMCID: PMC6482460.
  2. Rideout, J. M., Ozawa, E. T., Bourgeois, D. J., Chipman, M., & Overly, F. L. (2021). Can hospital adult code-teams and individual members perform high-quality CPR? A multicenter simulation-based study incorporating an educational intervention with CPR feedback. Resuscitation plus, 7, 100126.
  3. Abella, B. S., Sandbo, N., Vassilatos, P., & Alvarado, J. P. (2005). Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal. Circulation, 111(Feb), 428-434. https://doi.org/10.1161/01.CIR.0000153811.84257.59
  4. Gugelmin-Almeida, D., Tobase, L., Polastri, T. F., Peres, H. H. C., & Timerman, S. (2021). Do automated real-time feedback devices improve CPR quality? A systematic review of literature. Resuscitation Plus, 6, 100108.
  5. Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., O'Neil, B. J., Peberdy, M. A., Rittenberger, J. C. (2020). Part 3: Adult basic and advanced life support: 2020 american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16_suppl_2). https://doi.org/10.1161/cir.0000000000000916

 

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