Strategies to Improve Cardiac Arrest Survival A Time to Act (2015) / Chapter Skim
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7 Recommendations and Key Opportunities
7 Recommendations and Key Opportunities
Pages 363-398
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From page 363... ...
, cardiac arrest can strike indiscriminately and without warning, often leaving grieving family members and friends to question what could have been done differently. Regardless of the outcome, individuals who experience a cardiac arrest encounter many care providers -- including bystanders, first responders, emergency medical services (EMS)
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From page 364... ...
Building on the concept of a continously learning health care system, the committee identified foundational elements of a learning system of response for cardiac arrest and resuscitation research (see Table 7-1)
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From page 365... ...
Incentives Accountability and transparency -- In learning sys tems of response, incentives to improve care are created through the availability of data and ac countability to the public for local cardiac arrest incidence, survival, and neurological outcomes. Through dissemination of data and benchmarking at local, state, and national levels, the public and policy makers are better able to understand the public health burden of cardiac arrest as well as the quality of cardiac arrest treatment in their commu nities.
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From page 366... ...
. Because of the lack of national EMS and health care system performance metrics to guide cardiac arrest treatment, the quality, scope, and type of data collected varies across health care organizations.
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From page 367... ...
Holding EMS and health care systems accountable for performance first requires improving the state of data collection, reporting, and analysis across the cardiac arrest field. The committee has identified several key areas for action related to data collection and dissemination, including the development of a national cardiac arrest registry, standardization of terms used to measure patient treatment and outcomes, and identification of performance metrics that should be measured and recorded for all cardiac arrest patients.
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From page 368... ...
Other Opportunities • Define the nature and scope of the public health burden of cardiac arrest for at-risk or underserved populations, including minorities, women, children, and those living in rural areas. Subsequent research that is tailored to the unique needs of these populations as revealed by surveillance data.
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From page 369... ...
data, to help increase federal and state accountability for current system performance and promote actions to improve cardiac arrest outcomes. Specifically, CDC should • establish a cardiac arrest surveillance system for the nation that includes IHCA and OHCA data in pediatric and adult populations; • make data publicly available through appropriate mecha nisms to enable comparisons across data sets in order to increase public awareness about cardiac arrest incidence and treatments, improve accountability for the emergency medical services system and health care system perfor mance, and target interventions that will reduce disparities and improve patient outcomes; • identify and implement standardized definitions, criteria, and metrics (such as age, gender, race and ethnicity, socioec onomic status, and primary language)
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From page 370... ...
. In its effort to create a national cardiac arrest registry for reporting and tracking OHCA and IHCA incidence and outcomes, CDC should ensure that data from EMS agencies and hospitals are sufficient and reliable enough to provide a precise assessment of the public health burden of cardiac arrest in the United States.
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From page 371... ...
The committee suggests expanding data collection to include important predictors such as race and ethnicity, socioeconomic status, and primary language, when available, in order to identify potential disparities in cardiac arrest and to better target interventions to rectify these with the goal of improving national survival rates. A national surveillance system should collect accurate and complete data for OHCA and IHCA, regardless of whether the data sets are combined or separate.
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From page 372... ...
. Many communities that demonstrate high rates of survival and positive neurological outcomes have succeeded with the help of high-performing EMS systems and an engaged public that is trained in bystander CPR and the use of automated external defibrillators (AEDs)
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From page 373... ...
Identify or develop strategies for designing laws, school-based programs, and CPR training and PAD programs that promote improved outcomes through increases in early bystander CPR and defibrillation. • Identify proven and potential strategies for increasing rates of bystander CPR.
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From page 374... ...
Specifically, • State and local education departments should partner with training organizations and public advocacy groups to pro mote and facilitate CPR and AED training as a graduation requirement for middle and high school students; • Employers (e.g., federal agencies, private business owners, and schools) should be encouraged to maintain easy-to locate and clearly marked AEDs, provide CPR and AED training to their employees, and specifically include cardiac arrest in formal emergency response plans; and
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From page 375... ...
For example, new employee orientation, recurring professional education requirements, and annual health fairs could all be used to teach employees who have never received training and to refresh skills. CPR and AED training initiatives should also prioritize the mitigation of disparities in bystander CPR rates, by training populations that have a high risk of experiencing cardiac arrest, or that are more likely to witness an arrest.
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From page 376... ...
Digital coursework, simplified training aids, and abbreviated courses provide alternative ways to decrease the costs, without diminishing the effect of basic life support education. Creating a culture of action will not be easy, but it is necessary in order to make a real difference in survival rates nationwide.
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From page 377... ...
Advancing cardiac arrest treatment inside and outside the hospital will require developing a cardiac arrest registry with standardized definitions and metrics upon which research efforts can be based. Additional opportunities for improving patient outcomes include the creation of powerful diagnostic tools, training programs to development nontechnical resuscitation skills, and regional cardiac arrest care centers.
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From page 378... ...
• Explore the impact of standardized performance metrics and quality collaboratives on the capacity to measure and compare performance and outcomes data. • Investigate the effects of guidelines and patient-centered care models on hospital performance and patient outcomes.
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From page 379... ...
Systems As the informal agency for EMS, the National Highway Traffic Safety Administration (NHTSA) should coordinate with other federal agencies and representatives from private industry, states, professional organizations, first responders, EMS systems, and nonprofit organizations to promote uniformly high-quality emergency medical systems by • convening interested stakeholders to develop standardized dispatcher-assisted cardiopulmonary resuscitation (CPR)
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From page 380... ...
ASSESSING HOSPITAL PERFORMANCE TO IMPROVE CARDIAC ARREST OUTCOMES There is considerable variation in the treatment, care delivery, and outcomes across hospitals in the nation for IHCA and post-arrest care. A 2 Personal communication with D
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From page 381... ...
Recommendation 4. Set National Accreditation Standards Related to Cardiac Arrest for Hospital and Health Care Systems The Joint Commission -- in collaboration with the American Red Cross, the American Heart Association, hospital systems, hospi tals, professional organizations, and patient advocacy groups -- should develop and implement an accreditation standard for health care facilities specific to cardiac arrest care for adult and pediatric populations.
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From page 382... ...
The committee encourages The Joint Commission to work with guideline-setting organizations, such as the American Red Cross and the American Heart Association, and collaborate with hospitals, health care systems, and related stakeholders, including professional organizations and patient advocacy groups, in order to develop achievable national standards for hospital accreditation. This collaborative effort to develop national standards complements the committee's recommendation to create a national surveillance system for OHCA and IHCA, because accreditation standards will ensure completeness of data from hospitals as they adhere to collection and reporting requirements for accreditation.
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From page 383... ...
systems, health care systems, and hospitals should adopt formal, continuous quality improve ment programs for cardiac arrest response that • assign responsibility, authority, and accountability within each organization or agency for specific cardiac arrest measures; • implement core technical and nontechnical training, simula tion, and debriefing protocols to ensure that EMS and hospital personnel can respond competently to both adult and pediatric cardiac arrests; and • actively collaborate and share data to facilitate national, state, and local benchmarking for quality improvement. As described throughout this report, the small number of EMS systems, hospitals, and health care systems that have adopted CQI programs or are informally monitoring performance are demonstrating tremendous improvements in outcomes over time (Chan, 2015; Travers et al., 2010)
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From page 384... ...
The committee recognizes that CQI has been recommended in the American Heart Association's guidelines for the past decade (Meany et al., 2013)
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From page 385... ...
Effective treatment of cardiac arrest is also limited by enduring misconceptions of health care systems and professionals regarding the status of scientific guidelines and recommendations. Although the American Heart Association and International Liaison Committee on Resuscitation (ILCOR)
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From page 386... ...
These advances also hold promise for reshaping approaches to the cardiac arrest treatments and care delivery models. However, federal support for resuscitation research is dwindling, and resources are insufficient given the impact of cardiac arrest on society and the potential to decrease this burden through research advances.
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From page 387... ...
Accelerate Research on Pathophysiology, New Therapies, and Translation of Science for Cardiac Arrest In order to identify new, effective treatments for cardiac arrest, the National Institutes of Health (NIH) , the American Heart Association, and the U.S.
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From page 388... ...
To speed the development, evaluation, and use of effective treatments for cardiac arrest, and thus increase survival rates with positive neurological outcomes, the research enterprise will require sufficient scientific expertise, research capacity, efficiency, and focus on population health. A coordinated effort among multiple federal and nonfederal funders will be needed in order to increase support for pathophysiological and treatment research across the full time course of cardiac arrest -- from onset to long-term neurological outcome.
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From page 389... ...
Furthermore, building a more collaborative culture may also allow organizations to more easily overcome structural, contextual, and systemic barriers that may hinder collaboration. In light of the potential for collaboration to affect cardiac arrest outcomes and advance the field, the efforts of educational, advo
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From page 390... ...
; o representatives in local, state, and national governments; o research and academic institutions, as well as govern ment agencies involved in cardiac arrest policy and re search (e.g., the American Heart Association, the American Red Cross, NIH, CDC, and NHTSA) ; and o health care profession and medical organizations (e.g., American College of Emergency Physicians [ACEP]
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From page 391... ...
; • develop action strategies related to health policy, research funding and translation, continuous quality improvement, and public awareness and training; • produce and update toolkits for different stakeholders (e.g., emergency medical services [EMS] systems, hospitals, local health departments, and local health care providers)
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From page 392... ...
With the goal of developing strategic collaborations that could advance the resuscitation field, the NCAC would find the most success by actively engaging an inclusive array of cardiac arrest stakeholders, such as government agencies, professional organizations, academic researchers, state and local public health officials, patient and family advocacy groups, industry, health care providers, and international entities. Specific stakeholders could include, but are not limited to, ACEP, American Academy of Neurology, American College of Cardiology, the American Heart Association, American Hospital Association, American Nurses Association, the American Red Cross, Association of State and Territorial Health Officials, CDC, the Centers for Medicare & Medicaid Services, Heart Rhythm Society, The Joint Commission, Metropolitan Municipalities EMS Medical Directors Consortium, National Association of Community and County Health Officials, National Association of EMS Physicians, NHTSA, NIH institutes, Parent Heart Watch, Sudden Cardiac Arrest Association, Sudden Cardiac Arrest Foundation, U.S.
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From page 393... ...
Specifically, it requires collaboration among informed stakeholders and a new framework for cardiac arrest care that promotes real-time access to knowledge, multistakeholder partnerships, accountability and transparency, leadership to instill a culture of learning, and supportive system competencies. The consequences of inaction when faced with a cardiac arrest suggest that bystanders need to be prepared and willing to deliver basic life support (BLS)
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From page 394... ...
Many of the necessary pieces and strategies to improve cardiac arrest outcomes and to save lives already exist throughout the resuscitation field and within individual communities and health care systems across the United States. To effect change, this knowledge must be strategically shared and communicated among all stakeholders.
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From page 395... ...
A statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada,
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From page 396... ...
2013. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: A consensus statement from the American Heart Association.
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From page 397... ...
2014. Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: A state ment for healthcare professionals from a task force of the international liai son committee on resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscita tion, Heart and Stroke Foundation of Canada, InterAmerican Heart Founda tion, Resuscitation Council of Southern Africa, Resuscitation Council of Asia)
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