Theresa M Anderson1, Kayla Secrest1, Sarah L Krein1, Richard Schildhouse2, Timothy C Guetterman3, Molly Harrod2, Brad Trumpower1, Steven L Kronick4, James Pribble4, Paul S Chan5, Brahmajee K Nallamothu1,6. 1. Department of Internal Medicine (T.M.A., K.S., S.L. Krein, B.K.N., B.T.), University of Michigan Medical School, Ann Arbor. 2. Department of Internal Medicine, Veteran Affairs Ann Arbor Healthcare System, MI (R.S.). 3. Department of Family Medicine (T.C.G.), University of Michigan Medical School, Ann Arbor. 4. Department of Emergency Medicine (S.L. Kronick, J.P.), University of Michigan Medical School, Ann Arbor. 5. Department of Internal Medicine, Saint Luke's Health System, Kansas City, MO (P.S.C.). 6. Veterans Affairs Ann Arbor Center for Clinical Management Research, MI (S.L. Krein, M.H., B.K.N.).
Abstract
BACKGROUND: Survival outcomes following in-hospital cardiac arrest vary significantly across hospitals. Research suggests clinician education and training may play a role. We sought to identify best practices related to the education and training of resuscitation teams. METHODS: We conducted a descriptive qualitative analysis of semistructured interview data obtained from in-depth site visits conducted from 2016 to 2017 at 9 diverse hospitals within the American Heart Association "Get With The Guidelines" registry, selected based on in-hospital cardiac arrest survival performance (5 top-, 1 middle-, 3 low-performing). We assessed coded data related to education and training including systems learning, informal feedback and debrief, and formal learning through advanced cardiopulmonary life support and mock codes. Thematic analysis was used to identify best practices. RESULTS: In total, 129 interviews were conducted with a variety of hospital staff including nurses, chaplains, security guards, respiratory therapists, physicians, pharmacists, and administrators, yielding 78 hours and 29 minutes of interview time. Four themes related to training and education were identified: engagement, clear communication, consistency, and responsive leadership. Top-performing hospitals encouraged employee engagement with creative marketing of new programs and prioritizing hands-on learning over passive didactics. Clear communication was accomplished with debriefing, structured institutional review, and continual, frequent education for departments. Consistency was a cornerstone to culture change and was achieved with uniform policies for simulation practice as well as reinforced, routine practice (weekly, monthly, quarterly). Finally, top-performing hospitals had responsive leadership teams across multiple disciplines (nursing, respiratory therapy, pharmacy and medicine), who listened and adapted programs to fit the needs of their staff. CONCLUSIONS: Among top-performing hospitals excelling in in-hospital cardiac arrest survival, we identified core elements for education and training of resuscitation teams. Developing tools to expand these areas for hospitals may improve in-hospital cardiac arrest outcomes.
BACKGROUND: Survival outcomes following in-hospital cardiac arrest vary significantly across hospitals. Research suggests clinician education and training may play a role. We sought to identify best practices related to the education and training of resuscitation teams. METHODS: We conducted a descriptive qualitative analysis of semistructured interview data obtained from in-depth site visits conducted from 2016 to 2017 at 9 diverse hospitals within the American Heart Association "Get With The Guidelines" registry, selected based on in-hospital cardiac arrest survival performance (5 top-, 1 middle-, 3 low-performing). We assessed coded data related to education and training including systems learning, informal feedback and debrief, and formal learning through advanced cardiopulmonary life support and mock codes. Thematic analysis was used to identify best practices. RESULTS: In total, 129 interviews were conducted with a variety of hospital staff including nurses, chaplains, security guards, respiratory therapists, physicians, pharmacists, and administrators, yielding 78 hours and 29 minutes of interview time. Four themes related to training and education were identified: engagement, clear communication, consistency, and responsive leadership. Top-performing hospitals encouraged employee engagement with creative marketing of new programs and prioritizing hands-on learning over passive didactics. Clear communication was accomplished with debriefing, structured institutional review, and continual, frequent education for departments. Consistency was a cornerstone to culture change and was achieved with uniform policies for simulation practice as well as reinforced, routine practice (weekly, monthly, quarterly). Finally, top-performing hospitals had responsive leadership teams across multiple disciplines (nursing, respiratory therapy, pharmacy and medicine), who listened and adapted programs to fit the needs of their staff. CONCLUSIONS: Among top-performing hospitals excelling in in-hospital cardiac arrest survival, we identified core elements for education and training of resuscitation teams. Developing tools to expand these areas for hospitals may improve in-hospital cardiac arrest outcomes.
Authors: Timothy C Guetterman; Joan E Kellenberg; Sarah L Krein; Molly Harrod; Jessica L Lehrich; Theodore J Iwashyna; Steven L Kronick; Saket Girotra; Paul S Chan; Brahmajee K Nallamothu Journal: BMJ Qual Saf Date: 2019-08-16 Impact factor: 7.035
Authors: Raina M Merchant; Alexis A Topjian; Ashish R Panchal; Adam Cheng; Khalid Aziz; Katherine M Berg; Eric J Lavonas; David J Magid Journal: Circulation Date: 2020-10-21 Impact factor: 29.690
Authors: Mathias J. Holmberg; Catherine E. Ross; Garrett M. Fitzmaurice; Paul S. Chan; Jordan Duval-Arnould; Anne V. Grossestreuer; Tuyen Yankama; Michael W. Donnino; Lars W. Andersen Journal: Circ Cardiovasc Qual Outcomes Date: 2019-07-09
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: Oscar J L Mitchell; Eugene Yuriditsky; Nicholas J Johnson; Olivia Doran; David G Buckler; Stacie Neefe; Raghu R Seethala; Sergey Motov; Ari Moskowitz; Jarone Lee; Kelly M Griffin; Michael G S Shashaty; James M Horowitz; Benjamin S Abella Journal: Resuscitation Date: 2021-01-27 Impact factor: 5.262