title: The impact of hospital experience with out-of-hospital cardiac arrest patients on post cardiac arrest care.
abstract: Patient volume as a surrogate for institutional experience has been associated with quality of care indicators for a variety of illnesses. We evaluated the association between hospital experience with comatose out-of-hospital cardiac arrest (OHCA) patients and important care processes.
  
  
  
  This was a population-based, retrospective cohort study using data from 37 hospitals in Southern Ontario from 2007 to 2013. We included adults with atraumatic OHCA who were comatose on emergency department arrival and survived at least 6h. We excluded patients with a Do-Not-Resuscitate order or severe bleeding within 6h of hospital arrival. Multi-level logistic regression models estimated the association between average annual hospital volume of OHCA patients and outcomes. The primary outcome was successful targeted temperature management (TTM) and secondary outcomes included TTM initiation, premature withdrawal of life-sustaining therapy, and survival with good neurologic function.
  
  
  
  Our analysis included 2723 patients. For every increase of 10 in the average annual volume of eligible patients, the adjusted odds increased by 30% for successful TTM (OR 1.29, 95% CI 1.03-1.62) and by 38% for initiating TTM (OR 1.38, 95% CI 1.11-1.72). No significant association between patient volume and other secondary outcomes was observed.
  
  
  
  Patients arriving at hospitals with more experience treating comatose post cardiac arrest patients are more likely to have TTM initiated and to successfully reach target temperature. Our findings have implications for regional systems of care and knowledge translation efforts aiming to improve quality of care for this patient population.
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada. Electronic address: hworthington@gmail.com.
authors.forename: Heather
authors.initials: H
authors.lastname: Worthington
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada. Electronic address: pickettw@queensu.ca.
authors.forename: Will
authors.initials: W
authors.lastname: Pickett
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: morrisonl@smh.ca.
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: damon.scales@sunnybrook.ca.
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: zhanc@smh.ca.
authors.forename: Chun
authors.initials: C
authors.lastname: Zhan
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: lins@smh.ca.
authors.forename: Steve
authors.initials: S
authors.lastname: Lin
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: DorianP@smh.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: dainty@smh.ca.
authors.forename: Katie N
authors.initials: KN
authors.lastname: Dainty
authors.affiliation: Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Division of Respirology, Toronto General Research Institute, University Health Network and Mount Sinai Hospital, Toronto, Canada; Departments of Medicine and Physiology, Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. Electronic address: n.ferguson@utoronto.ca.
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: brooksst@kgh.kari.net.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Brooks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D003128:Coma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care; D016414:Resuscitation Orders; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Cardiac arrest; Health services; Post cardiac arrest care; Targeted temperature management