BACKGROUND: It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. OBJECTIVES: Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. RESEARCH DESIGN: Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. PARTICIPANTS: Adult patients with IHCA. MEASURES: Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. RESULTS: We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; P<0.0001). CONCLUSIONS: Case-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.
BACKGROUND: It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. OBJECTIVES: Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. RESEARCH DESIGN: Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. PARTICIPANTS: Adult patients with IHCA. MEASURES: Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. RESULTS: We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; P<0.0001). CONCLUSIONS: Case-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.
Authors: James E Calvin; Matthew T Roe; Anita Y Chen; Rajendra H Mehta; Gerard X Brogan; Elizabeth R Delong; Dan J Fintel; W Brian Gibler; E Magnus Ohman; Sidney C Smith; Eric D Peterson Journal: Ann Intern Med Date: 2006-11-21 Impact factor: 25.391
Authors: R O Cummins; D Chamberlain; M F Hazinski; V Nadkarni; W Kloeck; E Kramer; L Becker; C Robertson; R Koster; A Zaritsky; L Bossaert; J P Ornato; V Callanan; M Allen; P Steen; B Connolly; A Sanders; A Idris; S Cobbe Journal: Circulation Date: 1997-04-15 Impact factor: 29.690
Authors: Matthew D McHugh; Monica F Rochman; Douglas M Sloane; Robert A Berg; Mary E Mancini; Vinay M Nadkarni; Raina M Merchant; Linda H Aiken Journal: Med Care Date: 2016-01 Impact factor: 2.983
Authors: Raina M Merchant; Robert A Berg; Lin Yang; Lance B Becker; Peter W Groeneveld; Paul S Chan Journal: J Am Heart Assoc Date: 2014-01-31 Impact factor: 5.501
Authors: Jordan Michel Duval-Arnould; Heather Marie Newton; Leann McNamara; Branden Michael Engorn; Kareen Jones; Meghan Bernier; Pamela Dodge; Cheryl Salamone; Utpal Bhalala; Justin M Jeffers; Lilly Engineer; Marie Diener-West; Elizabeth Anne Hunt Journal: Crit Care Res Pract Date: 2018-05-09