In-hospital cardiopulmonary resuscitation: organization, management and training in hospitals of different levels of care.
BACKGROUND
: During recent years in-hospital cardiopulmonary resuscitation (CPR) management has received much attention. This can be attributed to the Utstein model for in-hospital CPR developed in 1997. The present status of in-hospital resuscitation management in Finnish hospitals is not known. Therefore, a study was designed to describe the organization of training and clinical management of CPR in Finnish hospitals of different levels of care.


METHODS
: In the summer of 2000, we performed a cross-sectional mail survey throughout Finland, including all district, central and university hospitals. The questionnaire outlined in detail in-hospital resuscitation management and training. For analysis the hospitals were divided into primary, secondary and tertiary groups, depending on levels of care.


RESULTS
: Most hospitals (72%) reported having a physician or a nurse in charge of resuscitation management and training. Training in advanced life support was more common among nurses (80%) than among physicians (53%). Surprisingly, a majority of respondents (75%) reported that they felt training in CPR was insufficient. On the general wards and on wards treating cardiac patients, defibrillation was in most cases performed by a physician (91% and 51%, respectively), and less often by a nurse (16% and 31%, respectively). In the secondary and tertiary hospitals cardiac arrest was managed by a cardiac arrest team (53% and 62%, respectively) and in the primary hospitals by the ward physician (56%), anesthesiologist or emergency physician on call (44%). Most hospitals used do-not-resuscitate orders (83%) but only 33% of the hospitals had a unified style of notation. Systematic data collection was practised in 55% of hospitals, predominantly by using a model of their own. Only a few hospitals (11%) used the in-hospital Utstein model.


CONCLUSIONS
: Our study showed that more attention needs to be paid to CPR management in Finnish hospitals. At present, 25% of hospitals do not have an appointed physician or nurse in charge of organizing CPR management. The study also revealed a lack of regular organized training in resuscitation for physicians. Fifty-five per cent of hospitals practise systematic data collection, but only 11% according to the Utstein template; and without which further quality assurance is difficult.
Skrifvars
M B
MB
Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland. markus.skifvars@kolumbus.fi
Castrén
M
M
Kurola
J
J
Rosenberg
P H
PH
D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000379:methods*; D003430:Cross-Sectional Studies; D003625:Data Collection; D004554:Electric Countershock; D005387:Finland; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy; D006761:Hospitals; D008021:Life Support Systems; D008991:Monitoring, Physiologic; D011785:Quality Assurance, Health Care; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires