Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest

Joyce Akwe; Penny Gunter; Anne Cadet; Joel Moorhead; Leslie Bao; Ancy Chemmalakuzhy

doi:doi:10.11648/j.ccr.20170103.15

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Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest

Joyce Akwe, Penny Gunter, Anne Cadet, Joel Moorhead, Leslie Bao, Ancy Chemmalakuzhy

Published in Cardiology and Cardiovascular Research (Volume 1, Issue 3)

Received: 31 May 2017 Accepted: 15 June 2017 Published: 24 July 2017

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Abstract

The time from cardiac arrest to the administration of Cardio Pulmonary Resuscitation (CPR) and defibrillation have been shown to influence the outcome of a cardiac arrest in the hospital setting. Both the time to defibrillation and the start of CPR could be influenced by several factors including patient’s physical environment, system based problems, promptness to calling for help, the availability of the code equipment and patient readiness for a CPR or Advance Cardiac Life Support (ACLS). In order to cut down on these barriers to a successful code, a pre-code readiness training was administered to hospital staff with various background and level of responsibilities. The goal of the program was to reduce the response time to in-hospital cardiac arrest by focusing on the factors which have been reported to increase the response time such as lack of a vascular access, equipment malfunction or even discrepancies in alerting hospital-wide resuscitation response. Twelve questions were prepared to address the main aspects that could reduce the time to defibrillation to below 2 minutes and contribute to the success of a code. A total of 125 volunteers were trained. First they completed a questionnaire with 12 questions on how to prepare both the patient and their environment to a possible emergent medical intervention or a cardiac arrest. Next, they received training on how they could assist in preparing a deteriorating patient or patient at a high risk of having a cardiac arrest during that admission. After the training, they were invited into the simulation center where there was a deteriorating virtual patient and a typical patient room environment was simulated, and a real life situation was simulated. There was a statistically significant difference in the before and after training response to each of the questions. Prior to the training, 968 answers to these questions were correct. After the training, 1484 answers were correct (Value is < 0.00001). The difference in the correct answers before and after the training was statistically significant for each of the questions. Most code situations are disorganized and the hypothesis is that recognizing a patient at a high risk of having a cardiac arrest and preparing the patient and his environment to a cardiac arrest may lead to a better outcome. This training program covered the most common patient related factors, environmental aspects and equipment related factors that could contribute to rapid intervention and consequently to a successful code.

Published in	Cardiology and Cardiovascular Research (Volume 1, Issue 3)
DOI	10.11648/j.ccr.20170103.15
Page(s)	94-97
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Response Time, Equipment Malfunction, Preparing High Risk Patients, Deteriorating Patient

References

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[2]	Mickey S. Eisenberg, and Terry J. Mengert. Cardiac Resuscitation. N Engl J Med 2001; 344: 1304-13132001 DOI: 10.1056/NEJM200104263441707.
[3]	Chan PS, Krein SL, Tang F, Iwashyna TJ, Harrod M, Kennedy M, Lehrich J, Kronick S, Nallamothu BK. Resuscitation practices associated with survival after in-hospital cardiac arrest: a nationwide survey. Jama cardiology. 2016 May 1; 1 (2): 189-97.
[4]	Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. New England Journal of Medicine. 2012 Nov 15; 367 (20): 1912-20.
[5]	Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan PW, Hoek TV, Halverson CC, Doering L, Peberdy MA, Edelson DP. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations. Circulation. 2013 Apr 9; 127 (14): 1538-63.
[6]	Skrifvars MB, Rosenberg PH, Finne P, et al. Evaluation of the in-hospital Utstein template in cardiopulmonary resuscitation in secondary hospitals. Resuscitation 2003; 56: 275-82.
[7]	Alan S. Go, MD; Dariush Mozaffarian, et al. The Heart Disease and Stroke Statistics - 2013 Update online on December 12, 2012. A Report From the American Heart Association http://circ.ahajournals.org/content/circulationaha/early/2012/12/12/CIR.0b013e31828124ad.full.pdf. Accessed 03/30/2017.
[8]	Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003; 58 (3): 297-308.
[9]	Chan PS, Krumholz HM, Nichol G, Nallamothu BK. Delayed time to defibrillation after in-hospital cardiac arrest. New England Journal of Medicine. 2008 Jan 3; 358 (1): 9-17.
[10]	Chen LM, Nallamothu BK, Spertus JA, Li Y, Chan PS. Association between a hospital’s rate of cardiac arrest incidence and cardiac arrest survival. JAMA internal medicine. 2013 Jul 8; 173 (13): 1186-95.
[11]	Chan PS, Nichol G, Krumholz HM, Spertus JA, Jones PG, Peterson ED, Rathore SS, Nallamothu BK. Racial differences in survival after in-hospital cardiac arrest. JAMA. 2009; 302 (11): 1195–1201.
[12]	Merchant RM, Becker LB, Abella BS, Asch DA, Groeneveld PW. Cost-effectiveness of therapeutic hypothermia after cardiac arrest. Circulation: Cardiovascular Quality and Outcomes. 2009; 2 (5): 421–428.
[13]	Ornato JP, Peberdy MA, Reid RD, Feeser VR, Dhindsa HS, NRCPR Investigators. Impact of resuscitation system errors on survival from in-hospital cardiac arrest. Resuscitation. 2012 Jan 31; 83 (1): 63-9.
[14]	Abella BS, Alvarado JP, Myklebust H, Edelson DP, Barry A, O’Hearn N, Hoek TL, Becker LB. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. Jama. 2005 Jan 19; 293 (3): 305-10.
[15]	Donoghue AJ, Nadkarni VM, Elliott M, Durbin D. Effect of hospital characteristics on outcomes from pediatric cardiopulmonary resuscitation: a report from the national registry of cardiopulmonary resuscitation. Pediatrics. 2006 Sep 1; 118 (3): 995-1001.

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APA Style

Joyce Akwe, Penny Gunter, Anne Cadet, Joel Moorhead, Leslie Bao, et al. (2017). Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest. Cardiology and Cardiovascular Research, 1(3), 94-97. https://doi.org/10.11648/j.ccr.20170103.15

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ACS Style

Joyce Akwe; Penny Gunter; Anne Cadet; Joel Moorhead; Leslie Bao, et al. Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest. Cardiol. Cardiovasc. Res. 2017, 1(3), 94-97. doi: 10.11648/j.ccr.20170103.15

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AMA Style

Joyce Akwe, Penny Gunter, Anne Cadet, Joel Moorhead, Leslie Bao, et al. Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest. Cardiol Cardiovasc Res. 2017;1(3):94-97. doi: 10.11648/j.ccr.20170103.15

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@article{10.11648/j.ccr.20170103.15,
  author = {Joyce Akwe and Penny Gunter and Anne Cadet and Joel Moorhead and Leslie Bao and Ancy Chemmalakuzhy},
  title = {Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest},
  journal = {Cardiology and Cardiovascular Research},
  volume = {1},
  number = {3},
  pages = {94-97},
  doi = {10.11648/j.ccr.20170103.15},
  url = {https://doi.org/10.11648/j.ccr.20170103.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20170103.15},
  abstract = {The time from cardiac arrest to the administration of Cardio Pulmonary Resuscitation (CPR) and defibrillation have been shown to influence the outcome of a cardiac arrest in the hospital setting. Both the time to defibrillation and the start of CPR could be influenced by several factors including patient’s physical environment, system based problems, promptness to calling for help, the availability of the code equipment and patient readiness for a CPR or Advance Cardiac Life Support (ACLS). In order to cut down on these barriers to a successful code, a pre-code readiness training was administered to hospital staff with various background and level of responsibilities. The goal of the program was to reduce the response time to in-hospital cardiac arrest by focusing on the factors which have been reported to increase the response time such as lack of a vascular access, equipment malfunction or even discrepancies in alerting hospital-wide resuscitation response. Twelve questions were prepared to address the main aspects that could reduce the time to defibrillation to below 2 minutes and contribute to the success of a code. A total of 125 volunteers were trained. First they completed a questionnaire with 12 questions on how to prepare both the patient and their environment to a possible emergent medical intervention or a cardiac arrest. Next, they received training on how they could assist in preparing a deteriorating patient or patient at a high risk of having a cardiac arrest during that admission. After the training, they were invited into the simulation center where there was a deteriorating virtual patient and a typical patient room environment was simulated, and a real life situation was simulated. There was a statistically significant difference in the before and after training response to each of the questions. Prior to the training, 968 answers to these questions were correct. After the training, 1484 answers were correct (Value is < 0.00001). The difference in the correct answers before and after the training was statistically significant for each of the questions. Most code situations are disorganized and the hypothesis is that recognizing a patient at a high risk of having a cardiac arrest and preparing the patient and his environment to a cardiac arrest may lead to a better outcome. This training program covered the most common patient related factors, environmental aspects and equipment related factors that could contribute to rapid intervention and consequently to a successful code.},
 year = {2017}
}

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TY  - JOUR
T1  - Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest
AU  - Joyce Akwe
AU  - Penny Gunter
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AU  - Joel Moorhead
AU  - Leslie Bao
AU  - Ancy Chemmalakuzhy
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N1  - https://doi.org/10.11648/j.ccr.20170103.15
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UR  - https://doi.org/10.11648/j.ccr.20170103.15
AB  - The time from cardiac arrest to the administration of Cardio Pulmonary Resuscitation (CPR) and defibrillation have been shown to influence the outcome of a cardiac arrest in the hospital setting. Both the time to defibrillation and the start of CPR could be influenced by several factors including patient’s physical environment, system based problems, promptness to calling for help, the availability of the code equipment and patient readiness for a CPR or Advance Cardiac Life Support (ACLS). In order to cut down on these barriers to a successful code, a pre-code readiness training was administered to hospital staff with various background and level of responsibilities. The goal of the program was to reduce the response time to in-hospital cardiac arrest by focusing on the factors which have been reported to increase the response time such as lack of a vascular access, equipment malfunction or even discrepancies in alerting hospital-wide resuscitation response. Twelve questions were prepared to address the main aspects that could reduce the time to defibrillation to below 2 minutes and contribute to the success of a code. A total of 125 volunteers were trained. First they completed a questionnaire with 12 questions on how to prepare both the patient and their environment to a possible emergent medical intervention or a cardiac arrest. Next, they received training on how they could assist in preparing a deteriorating patient or patient at a high risk of having a cardiac arrest during that admission. After the training, they were invited into the simulation center where there was a deteriorating virtual patient and a typical patient room environment was simulated, and a real life situation was simulated. There was a statistically significant difference in the before and after training response to each of the questions. Prior to the training, 968 answers to these questions were correct. After the training, 1484 answers were correct (Value is < 0.00001). The difference in the correct answers before and after the training was statistically significant for each of the questions. Most code situations are disorganized and the hypothesis is that recognizing a patient at a high risk of having a cardiac arrest and preparing the patient and his environment to a cardiac arrest may lead to a better outcome. This training program covered the most common patient related factors, environmental aspects and equipment related factors that could contribute to rapid intervention and consequently to a successful code.
VL  - 1
IS  - 3
ER  -

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Author Information

Joyce Akwe

Department of Medicine, Emory University School of Medicine, Veterans Affair Medical Center, Atlanta Ga, USA
Penny Gunter

Department of Medicine, Emory University School of Medicine, Veterans Affair Medical Center, Atlanta Ga, USA
Anne Cadet

Department of Medicine, Emory University School of Medicine, Veterans Affair Medical Center, Atlanta Ga, USA
Joel Moorhead

Department of Medicine, Emory University School of Medicine, Veterans Affair Medical Center, Atlanta Ga, USA
Leslie Bao

Department of Medicine, Emory University School of Medicine, Veterans Affair Medical Center, Atlanta Ga, USA
Ancy Chemmalakuzhy

Department of Medicine, Emory University School of Medicine, Veterans Affair Medical Center, Atlanta Ga, USA

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APA Style

Joyce Akwe, Penny Gunter, Anne Cadet, Joel Moorhead, Leslie Bao, et al. (2017). Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest. Cardiology and Cardiovascular Research, 1(3), 94-97. https://doi.org/10.11648/j.ccr.20170103.15

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ACS Style

Joyce Akwe; Penny Gunter; Anne Cadet; Joel Moorhead; Leslie Bao, et al. Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest. Cardiol. Cardiovasc. Res. 2017, 1(3), 94-97. doi: 10.11648/j.ccr.20170103.15

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AMA Style

Joyce Akwe, Penny Gunter, Anne Cadet, Joel Moorhead, Leslie Bao, et al. Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest. Cardiol Cardiovasc Res. 2017;1(3):94-97. doi: 10.11648/j.ccr.20170103.15

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@article{10.11648/j.ccr.20170103.15,
  author = {Joyce Akwe and Penny Gunter and Anne Cadet and Joel Moorhead and Leslie Bao and Ancy Chemmalakuzhy},
  title = {Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest},
  journal = {Cardiology and Cardiovascular Research},
  volume = {1},
  number = {3},
  pages = {94-97},
  doi = {10.11648/j.ccr.20170103.15},
  url = {https://doi.org/10.11648/j.ccr.20170103.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20170103.15},
  abstract = {The time from cardiac arrest to the administration of Cardio Pulmonary Resuscitation (CPR) and defibrillation have been shown to influence the outcome of a cardiac arrest in the hospital setting. Both the time to defibrillation and the start of CPR could be influenced by several factors including patient’s physical environment, system based problems, promptness to calling for help, the availability of the code equipment and patient readiness for a CPR or Advance Cardiac Life Support (ACLS). In order to cut down on these barriers to a successful code, a pre-code readiness training was administered to hospital staff with various background and level of responsibilities. The goal of the program was to reduce the response time to in-hospital cardiac arrest by focusing on the factors which have been reported to increase the response time such as lack of a vascular access, equipment malfunction or even discrepancies in alerting hospital-wide resuscitation response. Twelve questions were prepared to address the main aspects that could reduce the time to defibrillation to below 2 minutes and contribute to the success of a code. A total of 125 volunteers were trained. First they completed a questionnaire with 12 questions on how to prepare both the patient and their environment to a possible emergent medical intervention or a cardiac arrest. Next, they received training on how they could assist in preparing a deteriorating patient or patient at a high risk of having a cardiac arrest during that admission. After the training, they were invited into the simulation center where there was a deteriorating virtual patient and a typical patient room environment was simulated, and a real life situation was simulated. There was a statistically significant difference in the before and after training response to each of the questions. Prior to the training, 968 answers to these questions were correct. After the training, 1484 answers were correct (Value is < 0.00001). The difference in the correct answers before and after the training was statistically significant for each of the questions. Most code situations are disorganized and the hypothesis is that recognizing a patient at a high risk of having a cardiac arrest and preparing the patient and his environment to a cardiac arrest may lead to a better outcome. This training program covered the most common patient related factors, environmental aspects and equipment related factors that could contribute to rapid intervention and consequently to a successful code.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - Before First Two Minutes: A Quality Improvement Project Aimed at Decreasing the Time to Defibrillation for In-patients at High Risk of Having a Cardiac Arrest
AU  - Joyce Akwe
AU  - Penny Gunter
AU  - Anne Cadet
AU  - Joel Moorhead
AU  - Leslie Bao
AU  - Ancy Chemmalakuzhy
Y1  - 2017/07/24
PY  - 2017
N1  - https://doi.org/10.11648/j.ccr.20170103.15
DO  - 10.11648/j.ccr.20170103.15
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 94
EP  - 97
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20170103.15
AB  - The time from cardiac arrest to the administration of Cardio Pulmonary Resuscitation (CPR) and defibrillation have been shown to influence the outcome of a cardiac arrest in the hospital setting. Both the time to defibrillation and the start of CPR could be influenced by several factors including patient’s physical environment, system based problems, promptness to calling for help, the availability of the code equipment and patient readiness for a CPR or Advance Cardiac Life Support (ACLS). In order to cut down on these barriers to a successful code, a pre-code readiness training was administered to hospital staff with various background and level of responsibilities. The goal of the program was to reduce the response time to in-hospital cardiac arrest by focusing on the factors which have been reported to increase the response time such as lack of a vascular access, equipment malfunction or even discrepancies in alerting hospital-wide resuscitation response. Twelve questions were prepared to address the main aspects that could reduce the time to defibrillation to below 2 minutes and contribute to the success of a code. A total of 125 volunteers were trained. First they completed a questionnaire with 12 questions on how to prepare both the patient and their environment to a possible emergent medical intervention or a cardiac arrest. Next, they received training on how they could assist in preparing a deteriorating patient or patient at a high risk of having a cardiac arrest during that admission. After the training, they were invited into the simulation center where there was a deteriorating virtual patient and a typical patient room environment was simulated, and a real life situation was simulated. There was a statistically significant difference in the before and after training response to each of the questions. Prior to the training, 968 answers to these questions were correct. After the training, 1484 answers were correct (Value is < 0.00001). The difference in the correct answers before and after the training was statistically significant for each of the questions. Most code situations are disorganized and the hypothesis is that recognizing a patient at a high risk of having a cardiac arrest and preparing the patient and his environment to a cardiac arrest may lead to a better outcome. This training program covered the most common patient related factors, environmental aspects and equipment related factors that could contribute to rapid intervention and consequently to a successful code.
VL  - 1
IS  - 3
ER  -

Copy | Download