title: The System-Wide Effect of Real-Time Audiovisual Feedback and Postevent Debriefing for In-Hospital Cardiac Arrest: The Cardiopulmonary Resuscitation Quality Improvement Initiative.
abstract: OBJECTIVE
  To evaluate the effect of implementing real-time audiovisual feedback with and without postevent debriefing on survival and quality of cardiopulmonary resuscitation quality at in-hospital cardiac arrest.
  
  
  METHODS
  A two-phase, multicentre prospective cohort study.
  
  
  METHODS
  Three UK hospitals, all part of one National Health Service Acute Trust.
  
  
  METHODS
  One thousand three hundred and ninety-five adult patients who sustained an in-hospital cardiac arrest at the study hospitals and were treated by hospital emergency teams between November 2009 and May 2013.
  
  
  METHODS
  During phase 1, quality of cardiopulmonary resuscitation and patient outcomes were measured with no intervention implemented. During phase 2, staff at hospital 1 received real-time audiovisual feedback, whereas staff at hospital 2 received real-time audiovisual feedback supplemented by postevent debriefing. No intervention was implemented at hospital 3 during phase 2.
  
  
  RESULTS
  The primary outcome was return of spontaneous circulation. Secondary endpoints included other patient-focused outcomes, such as survival to hospital discharge, and process-focused outcomes, such as chest compression depth. Random-effect logistic and linear regression models, adjusted for baseline patient characteristics, were used to analyze the effect of the interventions on study outcomes. In comparison with no intervention, neither real-time audiovisual feedback (adjusted odds ratio, 0.62; 95% CI, 0.31-1.22; p=0.17) nor real-time audiovisual feedback supplemented by postevent debriefing (adjusted odds ratio, 0.65; 95% CI, 0.35-1.21; p=0.17) was associated with a statistically significant improvement in return of spontaneous circulation or any process-focused outcome. Despite this, there was evidence of a system-wide improvement in phase 2, leading to improvements in return of spontaneous circulation (adjusted odds ratio, 1.87; 95% CI, 1.06-3.30; p=0.03) and process-focused outcomes.
  
  
  CONCLUSIONS
  Implementation of real-time audiovisual feedback with or without postevent debriefing did not lead to a measured improvement in patient or process-focused outcomes at individual hospital sites. However, there was an unexplained system-wide improvement in return of spontaneous circulation and process-focused outcomes during the second phase of the study.
authors.affiliation: 1Heart of England NHS Foundation Trust, Birmingham, United Kingdom. 2Warwick Medical School, University of Warwick, Coventry, United Kingdom. 3Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA. 4School of Clinical and Experimental Medicine, College of Medical and Dental Science, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Keith
authors.initials: K
authors.lastname: Couper
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kimani
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.forename: Mehboob
authors.initials: M
authors.lastname: Chilwan
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Cooke
authors.forename: Robin P
authors.initials: RP
authors.lastname: Davies
authors.forename: Richard A
authors.initials: RA
authors.lastname: Field
authors.forename: Fang
authors.initials: F
authors.lastname: Gao
authors.forename: Sarah
authors.initials: S
authors.lastname: Quinton
authors.forename: Nigel
authors.initials: N
authors.lastname: Stallard
authors.forename: Sarah
authors.initials: S
authors.lastname: Woolley
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D005246:Feedback; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom