A cross-stakeholder approach to improving out-of-hospital cardiac arrest survival.

Humans United States / epidemiology Cardiopulmonary Resuscitation / methods Emergency Medical Services Out-of-Hospital Cardiac Arrest / therapy Quality Improvement Emergency Service, Hospital

Journal

American heart journal
ISSN: 1097-6744
Titre abrégé: Am Heart J
Pays: United States
ID NLM: 0370465

Informations de publication

Date de publication:
12 2023
Historique:
received: 26 05 2023
revised: 01 09 2023
accepted: 06 09 2023
medline: 20 11 2023
pubmed: 15 9 2023
entrez: 14 9 2023
Statut: ppublish

Résumé

Out-of-hospital cardiac arrest (OHCA) affects over 300,000 individuals per year in the United States with poor survival rates overall. A remarkable 5-fold difference in survival-to-hospital discharge rates exist across United States communities. We conducted a study using qualitative research methods comparing the system of care across sites in Michigan communities with varying OHCA survival outcomes, as measured by return to spontaneous circulation with pulse upon emergency department arrival. Major themes distinguishing higher performing sites were (1) working as a team, (2) devoting resources to coordination across agencies, and (3) developing a continuous quality improvement culture. These themes spanned the chain of survival framework for OHCA. By examining the unique processes, procedures, and characteristics of higher- relative to lower-performing sites, we gleaned lessons learned that appear to distinguish higher performers. The higher performing sites reported being the most collaborative, due in part to facilitation of system integration by progressive leadership that is willing to build bridges among stakeholders. Based on the distinguishing features of higher performing sites, we provide recommendations for toolkit development to improve survival in prehospital systems of care for OHCA.

Sections du résumé

BACKGROUND
Out-of-hospital cardiac arrest (OHCA) affects over 300,000 individuals per year in the United States with poor survival rates overall. A remarkable 5-fold difference in survival-to-hospital discharge rates exist across United States communities.
METHODS
We conducted a study using qualitative research methods comparing the system of care across sites in Michigan communities with varying OHCA survival outcomes, as measured by return to spontaneous circulation with pulse upon emergency department arrival.
RESULTS
Major themes distinguishing higher performing sites were (1) working as a team, (2) devoting resources to coordination across agencies, and (3) developing a continuous quality improvement culture. These themes spanned the chain of survival framework for OHCA. By examining the unique processes, procedures, and characteristics of higher- relative to lower-performing sites, we gleaned lessons learned that appear to distinguish higher performers. The higher performing sites reported being the most collaborative, due in part to facilitation of system integration by progressive leadership that is willing to build bridges among stakeholders.
CONCLUSIONS
Based on the distinguishing features of higher performing sites, we provide recommendations for toolkit development to improve survival in prehospital systems of care for OHCA.

Identifiants

DOI: 10.1016/j.ahj.2023.09.004 PMID: 37709108
pubmed: 37709108
pii: S0002-8703(23)00276-4
doi: 10.1016/j.ahj.2023.09.004
pii:
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

106-119

Subventions

Organisme : NHLBI NIH HHS
ID : R01 HL137964
Pays : United States

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Disclosure None reported.

Auteurs

Timothy C Guetterman (TC)

Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.

Jane Forman (J)

Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Qualitative and Mixed Methods Core, Center for Clinical Management Research, U.S. Department of Veterans Affairs, Ann Arbor, MI.

Sydney Fouche (S)

Acute Care Research Unit, University of Michigan, Ann Arbor, MI.

Kaitlyn Simpson (K)

Acute Care Research Unit, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI.

Michael D Fetters (MD)

Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI.

Christopher Nelson (C)

RAND Corporation, Santa Monica, CA.

Peter Mendel (P)

RAND Corporation, Santa Monica, CA.

Antony Hsu (A)

Trinity Health Ann Arbor Hospital, Ann Arbor, MI.

Jessica A Flohr (JA)

Acute Care Research Unit, University of Michigan, Ann Arbor, MI.

Robert Domeier (R)

Trinity Health Ann Arbor Hospital, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.

Rebal Rahim (R)

Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Malmo, Sweden.

Brahmajee K Nallamothu (BK)

Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI.

Mahshid Abir (M)

Acute Care Research Unit, University of Michigan, Ann Arbor, MI; RAND Corporation, Santa Monica, CA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI. Electronic address: mabir@rand.org.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A cross-stakeholder approach to improving...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › États-Unis › A cross-stakeholder approach to improving...
questionsmedicales.fr › Thérapeutique › Traitement d'urgence › Réanimation › Réanimation cardiopulmonaire › A cross-stakeholder approach to improving...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › A cross-stakeholder approach to improving...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Arrêt cardiaque › Arrêt cardiaque hors hôpital › A cross-stakeholder approach to improving...
questionsmedicales.fr › Administration des services de santé › Amélioration de la qualité › A cross-stakeholder approach to improving...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › A cross-stakeholder approach to improving...