title: Perception of CPR quality: Influence of CPR feedback, Just-in-Time CPR training and provider role.
abstract: OBJECTIVE
  Many healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions.
  
  
  METHODS
  We conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm.
  
  
  RESULTS
  Participants overestimated achieving adequate chest compression depth (mean difference range: 16.1-60.6%) and rate (range: 0.2-51%), and underestimated chest compression fraction (0.2-2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth (p<0.001). Accurate estimation of CPR quality was poor for chest compression depth (0-13%), rate (5-46%) and chest compression fraction (60-63%). Perception of depth is more accurate in CPR providers versus team leaders (27.8% vs. 7.4%; p=0.043) when using real-time feedback.
  
  
  CONCLUSIONS
  Healthcare providers' visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training.
authors.affiliation: University of Calgary, KidSim-ASPIRE Research Program, Division of Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta, Canada T3B 6A8. Electronic address: chenger@me.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Hasbro Children's Hospital, Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903, USA. Electronic address: foverly@lifespan.org.
authors.forename: Frank
authors.initials: F
authors.lastname: Overly
authors.affiliation: Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA. Electronic address: dk2592@cumc.columbia.edu.
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.affiliation: The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address: nadkarni@chop.edu.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, Canada T3B 6A8. Electronic address: jeffylin@hotmail.com.
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Lin
authors.affiliation: British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4. Electronic address: qdoan@cw.bc.ca.
authors.forename: Quynh
authors.initials: Q
authors.lastname: Doan
authors.affiliation: Stollery Children's Hospital, University of Alberta, 8215 112 St NW, Edmonton, AB, Canada T6G 2L9. Electronic address: jon.duff@albertahealthservices.ca.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Duff
authors.affiliation: Children's of Alabama, University of Alabama at Birmingham, 1600 7th Ave, S. Birmingham, AL 35233, USA. Electronic address: ntofil@peds.uab.edu.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Tofil
authors.affiliation: Montreal Children's Hospital, McGill University, 2300 Tupper St, Montreal, QC, Canada H3H 1P3. Electronic address: farhan.bhanji@mcgill.ca.
authors.forename: Farhan
authors.initials: F
authors.lastname: Bhanji
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University School of Medicine, 225 E Chicago Ave, Chicago, IL 60611, USA. Electronic address: m-adler@northwestern.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Adler
authors.affiliation: Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA. Electronic address: echarno1@jhmi.edu.
authors.forename: Alex
authors.initials: A
authors.lastname: Charnovich
authors.affiliation: Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA. Electronic address: ehunt@jhmi.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.affiliation: Hasbro Children's Hospital, Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903, USA. Electronic address: lbrown8@lifespan.org.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Brown
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000379:methods / Q000523:psychology; D056228:Feedback, Sensory; D005260:Female; D006282:Health Personnel / Q000523:psychology / Q000592:standards; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007318:Inservice Training / Q000379:methods; D008297:Male; D017063:Outcome Assessment, Health Care; D024382:Professional Role; D058996:Quality Improvement; D000066908:Simulation Training / Q000379:methods*; D012938:Social Perception
keywords: Cardiopulmonary resuscitation; Chest compressions; Perception; Quality; Resuscitation