TY - JOUR
T1 - Nursing roles for in-hospital cardiac arrest response
T2 - Higher versus lower performing hospitals
AU - Guetterman, Timothy C.
AU - Kellenberg, Joan E.
AU - Krein, Sarah L.
AU - Harrod, Molly
AU - Lehrich, Jessica L.
AU - Iwashyna, Theodore J.
AU - Kronick, Steven L.
AU - Girotra, Saket
AU - Chan, Paul S.
AU - Nallamothu, Brahmajee K.
N1 - Funding Information:
The study was supported by the National Institutes of Health (5R01HL123980-03) (K01 LM012739-01).
Funding Information:
Health (5R01HL123980-03) (K01 LM012739-01). Competing interests PC receives funding from the National Institutes of Health and has received consultant funding from the American Heart Association and Optum Rx. BK is a principal investigator or co-investigator on research grants from the NIH, VA HSR&D, the American Heart Association, Apple, Inc, and Toyota. He also receives compensation as Editor-in-Chief of Circulation: Cardiovascular Quality & Outcomes, a journal of the American Heart Association. Finally, he is a co-inventor on U.S. Utility Patent Number US15/356,012 (US20170148158A1) entitled “Automated Analysis of Vasculature in Coronary Angiograms” that uses software technology with signal processing and machine learning to automate the reading of coronary angiograms, held by the University of Michigan. The patent is licensed to AngioInsight, Inc., in which BK holds ownership shares (although it has yet to be funded). None of these are related to the current work. Patient consent for publication Not required. Ethics approval The University of Michigan Institutional Review Board approved this study (HUM00095267). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request.
Publisher Copyright:
© Author(s).
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Background Good outcomes for in-hospital cardiac arrest (IHCA) depend on a skilled resuscitation team, prompt initiation of high-quality cardiopulmonary resuscitation and defibrillation, and organisational structures to support IHCA response. We examined the role of nurses in resuscitation, contrasting higher versus lower performing hospitals in IHCA survival. Methods We conducted a descriptive qualitative study at nine hospitals in the American Heart Association's Get With The Guidelines-Resuscitation registry, purposefully sampling hospitals that varied in geography, academic status, and risk-standardised IHCA survival. We conducted 158 semistructured interviews with nurses, physicians, respiratory therapists, pharmacists, quality improvement staff, and administrators. Qualitative thematic text analysis followed by type-building text analysis identified distinct nursing roles in IHCA care and support for roles. Results Nurses played three major roles in IHCA response: bedside first responder, resuscitation team member, and clinical or administrative leader. We found distinctions between higher and lower performing hospitals in support for nurses. Higher performing hospitals emphasised training and competency of nurses at all levels; provided organisational flexibility and responsiveness with nursing roles; and empowered nurses to operate at a higher scope of clinical practice (eg, bedside defibrillation). Higher performing hospitals promoted nurses as leaders - administrators supporting nurses in resuscitation care at the institution, resuscitation team leaders during resuscitation and clinical champions for resuscitation care. Lower performing hospitals had more restrictive nurse roles with less emphasis on systematically identifying improvement needs. Conclusion Hospitals that excelled in IHCA survival emphasised mentoring and empowering front-line nurses and ensured clinical competency and adequate nursing training for IHCA care. Though not proof of causation, nurses appear to be critical to effective IHCA response, and how to support their role to optimise outcomes warrants further investigation.
AB - Background Good outcomes for in-hospital cardiac arrest (IHCA) depend on a skilled resuscitation team, prompt initiation of high-quality cardiopulmonary resuscitation and defibrillation, and organisational structures to support IHCA response. We examined the role of nurses in resuscitation, contrasting higher versus lower performing hospitals in IHCA survival. Methods We conducted a descriptive qualitative study at nine hospitals in the American Heart Association's Get With The Guidelines-Resuscitation registry, purposefully sampling hospitals that varied in geography, academic status, and risk-standardised IHCA survival. We conducted 158 semistructured interviews with nurses, physicians, respiratory therapists, pharmacists, quality improvement staff, and administrators. Qualitative thematic text analysis followed by type-building text analysis identified distinct nursing roles in IHCA care and support for roles. Results Nurses played three major roles in IHCA response: bedside first responder, resuscitation team member, and clinical or administrative leader. We found distinctions between higher and lower performing hospitals in support for nurses. Higher performing hospitals emphasised training and competency of nurses at all levels; provided organisational flexibility and responsiveness with nursing roles; and empowered nurses to operate at a higher scope of clinical practice (eg, bedside defibrillation). Higher performing hospitals promoted nurses as leaders - administrators supporting nurses in resuscitation care at the institution, resuscitation team leaders during resuscitation and clinical champions for resuscitation care. Lower performing hospitals had more restrictive nurse roles with less emphasis on systematically identifying improvement needs. Conclusion Hospitals that excelled in IHCA survival emphasised mentoring and empowering front-line nurses and ensured clinical competency and adequate nursing training for IHCA care. Though not proof of causation, nurses appear to be critical to effective IHCA response, and how to support their role to optimise outcomes warrants further investigation.
KW - health services research
KW - nurses
KW - quality improvement
KW - standards of care
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U2 - 10.1136/bmjqs-2019-009487
DO - 10.1136/bmjqs-2019-009487
M3 - Article
C2 - 31420410
AN - SCOPUS:85070959580
SN - 2044-5415
VL - 28
SP - 916
EP - 924
JO - BMJ Quality and Safety
JF - BMJ Quality and Safety
IS - 11
ER -