title: A failed attempt to improve quality of out-of-hospital CPR through performance evaluation.
abstract: BACKGROUND
  Quality of CPR performed by professionals has been reported to be substandard even with automated corrective feedback. Our hypothesis was that providing CPR performance evaluation (CPR-PE) to three ambulance services would facilitate local education and implementation of CPR guidelines and, consequently, improve CPR quality.
  
  
  METHODS
  Quality of CPR in 85 consecutive cases of adult out-of-hospital cardiac arrests after CPR-PE was compared to 39 cases prior to CPR-PE. Real-time automated verbal and visual feedback on CPR performance was given in all cases. No general implementation strategy was provided because the sites were expected to use the CPR-PEs in development of local strategies. Because the strategies were expected to vary, the sites were analyzed separately.
  
  
  RESULTS
  No significant improvement was seen in quality of CPR after CPR-PE. No chest compressions were given 40% of the time before versus 41% after CPR-PE. The median (95% confidence interval) percentage of chest compressions within the recommended depth range (38-51 mm) was 35% (27-57) before versus 51% (42-60) after CPR-PE (p = 0.12). In site-specific analysis, chest compressions within guideline depth increased from 31% to 61% after CPR-PE (p = 0.05) in one site.
  
  
  CONCLUSIONS
  Overall our attempt to improve CPR-quality was unsuccessful. Quality improvement likely requires a full range of implementation strategies to change current attitudes and practices.
authors: Institute for Experimental Medical Research, Ulleval University Hospital, Oslo, Norway. t.m.olasveengen@medisin.uio.no
authors: Theresa Mariero
authors: TM
authors: Olasveengen
authors: Ann-Elin
authors: AE
authors: Tomlinson
authors: Lars
authors: L
authors: Wik
authors: Kjetil
authors: K
authors: Sunde
authors: Petter Andreas
authors: PA
authors: Steen
authors: Helge
authors: H
authors: Myklebust
authors: Jo
authors: J
authors: Kramer-Johansen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*