Heather Worthington1, Will Pickett2, Laurie J Morrison3, Damon C Scales4, Chun Zhan5, Steve Lin6, Paul Dorian7, Katie N Dainty8, Niall D Ferguson9, Steven C Brooks10. 1. Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada. Electronic address: hworthington@gmail.com. 2. Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada. Electronic address: pickettw@queensu.ca. 3. Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: morrisonl@smh.ca. 4. Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: damon.scales@sunnybrook.ca. 5. Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: zhanc@smh.ca. 6. Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: lins@smh.ca. 7. Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: DorianP@smh.ca. 8. Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: dainty@smh.ca. 9. Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Division of Respirology, Toronto General Research Institute, University Health Network and Mount Sinai Hospital, Toronto, Canada; Departments of Medicine and Physiology, Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. Electronic address: n.ferguson@utoronto.ca. 10. Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: brooksst@kgh.kari.net.
Abstract
OBJECTIVE: Patient volume as a surrogate for institutional experience has been associated with quality of care indicators for a variety of illnesses. We evaluated the association between hospital experience with comatose out-of-hospital cardiac arrest (OHCA) patients and important care processes. METHODS: This was a population-based, retrospective cohort study using data from 37 hospitals in Southern Ontario from 2007 to 2013. We included adults with atraumatic OHCA who were comatose on emergency department arrival and survived at least 6h. We excluded patients with a Do-Not-Resuscitate order or severe bleeding within 6h of hospital arrival. Multi-level logistic regression models estimated the association between average annual hospital volume of OHCA patients and outcomes. The primary outcome was successful targeted temperature management (TTM) and secondary outcomes included TTM initiation, premature withdrawal of life-sustaining therapy, and survival with good neurologic function. RESULTS: Our analysis included 2723 patients. For every increase of 10 in the average annual volume of eligible patients, the adjusted odds increased by 30% for successful TTM (OR 1.29, 95% CI 1.03-1.62) and by 38% for initiating TTM (OR 1.38, 95% CI 1.11-1.72). No significant association between patient volume and other secondary outcomes was observed. CONCLUSIONS: Patients arriving at hospitals with more experience treating comatose post cardiac arrest patients are more likely to have TTM initiated and to successfully reach target temperature. Our findings have implications for regional systems of care and knowledge translation efforts aiming to improve quality of care for this patient population.
OBJECTIVE:Patient volume as a surrogate for institutional experience has been associated with quality of care indicators for a variety of illnesses. We evaluated the association between hospital experience with comatose out-of-hospital cardiac arrest (OHCA) patients and important care processes. METHODS: This was a population-based, retrospective cohort study using data from 37 hospitals in Southern Ontario from 2007 to 2013. We included adults with atraumatic OHCA who were comatose on emergency department arrival and survived at least 6h. We excluded patients with a Do-Not-Resuscitate order or severe bleeding within 6h of hospital arrival. Multi-level logistic regression models estimated the association between average annual hospital volume of OHCA patients and outcomes. The primary outcome was successful targeted temperature management (TTM) and secondary outcomes included TTM initiation, premature withdrawal of life-sustaining therapy, and survival with good neurologic function. RESULTS: Our analysis included 2723 patients. For every increase of 10 in the average annual volume of eligible patients, the adjusted odds increased by 30% for successful TTM (OR 1.29, 95% CI 1.03-1.62) and by 38% for initiating TTM (OR 1.38, 95% CI 1.11-1.72). No significant association between patient volume and other secondary outcomes was observed. CONCLUSIONS:Patients arriving at hospitals with more experience treating comatose post cardiac arrestpatients are more likely to have TTM initiated and to successfully reach target temperature. Our findings have implications for regional systems of care and knowledge translation efforts aiming to improve quality of care for this patient population.
Authors: Amelia Xin Chun Goh; Jie Cong Seow; Melvin Yong Hao Lai; Nan Liu; Yi Man Goh; Marcus Eng Hock Ong; Shir Lynn Lim; Jamie Sin Ying Ho; Jun Wei Yeo; Andrew Fu Wah Ho Journal: JAMA Netw Open Date: 2022-05-02
Authors: Ryan Huebinger; Jordan Thomas; Benjamin S Abella; John Waller-Delarosa; Rabab Al-Araji; Richard Witkov; Normandy Villa; Peter Nikonowicz; Taylor Renbarger; Micah Panczyk; Bentley Bobrow Journal: Resusc Plus Date: 2022-04-05