At the end of a baseball season, a team’s win-loss record is the ultimate judgment on their performance. But no manager would rely on that alone to make adjustments to the lineup. They need a more detailed breakdown of the team’s performance to help decide which pitcher to start or which outfielder to bench. Did the team have a losing streak because they didn’t score enough runs? Or was the offense fine but the bullpen let them down? Teams that make adjustments based on what’s working and what’s not usually come out on top.
In the same way, hospital administrators shouldn’t rely solely on how many patients live or die after doctors administer CPR for cardiac arrest to determine how well they’re doing. If survival rates go down, they’d want to know why. Is the equipment not up to par? Is there a lack of training? One would think that CPR practices—and the means for evaluating them—would be fairly standard across the country. But a recent study published in the Journal of Hospital Medicine found that resuscitation practices vary widely in hospitals across the United States.
“Everybody needs to be able to do CPR, but nobody gives you any guidelines as to how you’re supposed to ensure that it gets done appropriately,” said Dana Edelson, MD, Assistant Professor of Medicine at the University of Chicago Medicine and lead author on the study.
Of the 439 hospitals surveyed, around 90 percent had rapid response teams for performing CPR and used standardized defibrillator equipment throughout their facilities. But 80 percent reported at least one barrier to being able to monitor and improve the quality of their CPR practices, like inadequate training or lack of someone in a leadership role who can champion the cause for improvement.
Technology can provide a big boost to improve CPR success rates. At the University of Chicago, doctors use defibrillators equipped to measure the depth and timing of chest compressions. The machine provides real-time feedback on performance, literally talking to the doctor to say, “compress a little deeper” or “ventilate less often.”
Only 4 percent of the hospitals surveyed used this type of assist technology, however. Edelson cited slow adoption rates and the obvious expense of equipping a hospital with a new set of defibrillators, yet another barrier to effectively improving CPR quality in many smaller institutions.
The American Heart Association publishes guidelines every five years to outline their recommendations for emergency cardiovascular care. The last set of guidelines was published in 2010, with the next round underway for 2015. These recommendations serve as a de facto standard of care, but the study found differences in how they were implemented, especially in smaller, non-teaching hospitals that have fewer resources and staff.
Despite such variability, Edelson said this study provides useful context for hospitals trying to assess their CPR practices by comparing themselves to peers, like a baseball manager eyeing the competition in a pennant race.
“You lose sense of what’s standard practice when you just practice in one institution,” she said. “It’s just helpful to know what other hospitals are doing, and be able to understand where we fit in terms of the vast spectrum of hospitals out there.”
Edelson D.P., Mary E. Mancini, Daniel P. Davis, Elizabeth A. Hunt, Joseph A. Miller & Benjamin S. Abella (2014). Hospital cardiac arrest resuscitation practice in the United States: A nationally representative survey, Journal of Hospital Medicine, 9 (6) 353-357. DOI: http://dx.doi.org/10.1002/jhm.2174