title: A performance improvement-based resuscitation programme reduces arrest incidence and increases survival from in-hospital cardiac arrest.
abstract: BACKGROUND
  Traditional resuscitation training models are inadequate to achieving and maintaining resuscitation competency. This analysis evaluates the effectiveness of a novel, performance improvement-based inpatient resuscitation programme.
  
  
  METHODS
  This was a prospective, before-and-after study conducted in an urban, university-affiliated hospital system. All inpatient adult cardiac arrest victims without an active Do Not Attempt Resuscitation order from July 2005 to June 2012 were included. The advanced resuscitation training (ART) programme was implemented in Spring 2007 and included a unique treatment algorithm constructed around the capabilities of our providers and resuscitation equipment, a training programme with flexible format and content including early recognition concepts, and a comprehensive approach to performance improvement feeding directly back into training. Our inpatient resuscitation registry and electronic patient care record were used to quantify arrest rates and survival-to-hospital discharge before and after ART programme implementation. Multiple logistic regression analysis was used to adjust for age, gender, location of arrest, initial rhythm, and time of day.
  
  
  RESULTS
  A total of 556 cardiac arrest victims were included (182 pre- and 374 post-ART). Arrest incidence decreased from 2.7 to 1.2 per 1000 patient discharges in non-ICU inpatient units, with no change in ICU arrest rate. An increase in survival-to-hospital discharge from 21 to 45% (p < 0.01) was observed following ART programme implementation. Adjusted odds ratios for survival-to-discharge (OR 2.2, 95% CI 1.4-3.4) and good neurological outcomes (OR 3.0, 95% CI 1.7-5.3) reflected similar improvements. Arrest-related deaths decreased from 2.1 to 0.5 deaths per 1000 patient discharges in non-ICU areas and from 1.5 to 1.3 deaths per 1000 patient discharges in ICU areas, and overall hospital mortality decreased from 2.2% to 1.8%.
  
  
  CONCLUSIONS
  Implementation of a novel, performance improvement-based inpatient resuscitation programme was associated with a decrease in the incidence of cardiac arrest and improved clinical outcomes.
authors.affiliation: Department of Emergency Medicine, University of California at San Diego, United States. Electronic address: danieldavismd@gmail.com.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Davis
authors.affiliation: Department of Nursing Education, Development, Research, University of California at San Diego, United States.
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Graham
authors.affiliation: Division of Cardiology, University of California at San Diego, United States; Division of Cardiology, Ohio State University, United States.
authors.forename: Ruchika D
authors.initials: RD
authors.lastname: Husa
authors.affiliation: Department of Nursing, University of California at San Diego, United States.
authors.forename: Brenna
authors.initials: B
authors.lastname: Lawrence
authors.affiliation: Department of Anesthesiology, University of California at San Diego, United States.
authors.forename: Anushirvan
authors.initials: A
authors.lastname: Minokadeh
authors.affiliation: School of Medicine, University of California at San Diego, United States.
authors.forename: Katherine
authors.initials: K
authors.lastname: Altieri
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California at San Diego, United States.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Sell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D004502:Education, Medical, Continuing / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement; D012042:Registries; D013997:Time Factors; D055815:Young Adult
keywords: CPR; Cardiac arrest; Hospital; Inpatient; Resuscitation; Training