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Top Performing Hospitals for In-Hospital Cardiac Arrest

A Summary Review for "How Do Resuscitation Teams at Top Performing Hospitals for In-Hospital Cardiac Arrest Succeed?"

This qualitative study notes four areas that impact in-hospital arrests – Team Design, Team Composition and Roles, Communication and Leadership, and Training and Educational Efforts. Here is a quick summary of the article which you can read here.  

Code Team Design 

"In general, top-performing hospitals had dedicated or designated resuscitation teams versus ad hoc resuscitation teams at non–top-performing hospitals."

Team Composition and Roles 

Lucas Device

"Top-performing hospitals also spent time empowering bedside nurses in their roles as first responders, including allowing them to defibrillate without the presence of physicians if indicated."

"At non–top-performing hospitals, resident physicians were, at times, described as a weakness given the frequent turnover of trainees"

We see the code team roles in terms of a Super Bowl 53 team analogy. If our team is in the Super Bowl, why in the world would you let our team's game plan be managed by a high school JV coach? Ok some unwittingly naive first year resident (or junior) will say, "But how am I going to learn?" Hog wash! I've not been to a code yet which provided a half decent learning environment. At best our code teams only show the wrong way to run a code. Yes education is important but use the buddy system and require the JV coach (i.e. resident/junior) to prove they know what they are doing in a code while they stand beside the head coach (i.e. attending).

Communication and Leadership

"At 1 top-performing hospital, good leadership was highly valued, regardless of whether the team leader was a physician or nurse." Yes sometimes the nurse is better suited to run the code.

Training and Educational Efforts 

Mock Code in the ICU

"A notable example was mock codes…Specifically, mock codes were: (1) unplanned and held on a regular basis, (2) conducted in actual patient rooms rather than simulated environments, (3) multidisciplinary, and (4) included structured post debriefing.

We will give training the last word (after all that's what the CPR Training Company is all about)…..Your team (someone's life) is facing the greatest long shot in the history of sports (living). Which code team wins? The code team which drills as closely to the real game conditions or the team which took an online HeartCode training and completed their ACLS skills on an RQI/VAM platform? The collective resuscitation team outcomes of every hospital in the world will never improve unless healthcare stops putting all the emphasis on a certification card and starts requiring staff to be part of routine mock codes.

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