In-hospital cardiac arrest (IHCA) is a common event that is associated with poor patient outcomes. Yet, some hospitals have been consistently more successful in preventing and treating IHCA than others. While this is thought to be explained by the adoption of key strategies that improve care processes for IHCA, how these strategies are actually utilized in routine practice and the underlying factors contributing to their successful implementation remain largely unknown. Further, an integrative approach that examines strategies used during IHCA and those employed before and after these events has not been previously undertaken. This study will build on extensive prior work by our investigative team using the American Heart Association's Get With The Guidelines (GWTG)- Resuscitation registry and leverage our team's expertise in IHCA and qualitative research. The proposed HEROICA study will lay the foundation for future quality improvement efforts in IHCA by defining 'best practices'adopted by top-performing hospitals to address these events as well as potential barriers to their implementation. We will use a sequential mixed-methods approach to accomplish this goal, integrating quantitative and qualitative analyses. Its 3 Aims will: (1) identfy top- performing hospitals in preventing and treating IHCA within the GWTG-Resuscitation registry;(2) identify 'best practices'at the top-performing sites through semi-structured qualitative interviews;and (3) validate the practices associated with low IHCA incidence and high IHCA survival at top-performing sites. Findings from the study will be used to construct a toolkit of 'best practices'- the Code Blue Bundle. Upon successful completion of this research, we will partner closely with the American Heart Association (AHA) and the GWTG-Resuscitation registry to develop a national quality improvement program that will implement the Code Blue Bundle. Thus, the HEROICA study will increase the capacity of the NHLBI to improve outcomes for patients who suffer an IHCA by providing hospitals with practical and actionable strategies that can be implemented broadly to reduce the incidence and improve the survival of IHCA.

Public Health Relevance

As cardiac arrests occur frequently in U.S. hospitals, this study will enable us to understand why some hospitals are much better at preventing and treating this condition than the rest of the nation. By identifying the strategies used by these to-performing hospitals, our hope is to be able to share these 'best practices'with all hospitals so that fewer patients experience and die of cardiac arrests in the hospital setting.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL123980-01
Application #
8757524
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Cooper, Lawton S
Project Start
2014-08-01
Project End
2019-05-31
Budget Start
2014-08-01
Budget End
2015-05-31
Support Year
1
Fiscal Year
2014
Total Cost
$479,874
Indirect Cost
$95,252
Name
Saint Luke's Hospital
Department
Type
DUNS #
073039653
City
Kansas City
State
MO
Country
United States
Zip Code
64111
Kaufman, Brystana G; Kim, Sunghee; Pieper, Karen et al. (2018) Disease understanding in patients newly diagnosed with atrial fibrillation. Heart 104:494-501
Patel, Krishna K; Arnold, Suzanne V; Chan, Paul S et al. (2018) Validation of the Seattle angina questionnaire in women with ischemic heart disease. Am Heart J 201:117-123
Kutty, Shelby; Jones, Philip G; Karels, Quentin et al. (2018) Association of Pediatric Medical Emergency Teams With Hospital Mortality. Circulation 137:38-46
Chan, Maya L; Spertus, John A; Tang, Yuanyuan et al. (2018) Implications of a recurrent in-hospital cardiac arrest on survival and neurological outcomes. Am Heart J 202:139-143
Gupta, Dipti; Tang, Fengming; Masoudi, Frederick A et al. (2018) Practitioner Gender and Quality of Care in Ambulatory Cardiology Practices: A Report From the National Cardiovascular Data Practice Innovation and Clinical Excellence (PINNACLE) Registry. J Cardiovasc Nurs 33:255-260
Sinha, Shashank S; Moloci, Nicholas M; Ryan, Andrew M et al. (2018) The Effect of Medicare Accountable Care Organizations on Early and Late Payments for Cardiovascular Disease Episodes. Circ Cardiovasc Qual Outcomes 11:e004495
Nallamothu, Brahmajee K; Guetterman, Timothy C; Harrod, Molly et al. (2018) How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study. Circulation 138:154-163
Patel, Krishna K; Spertus, John A; Khariton, Yevgeniy et al. (2018) Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest. Circulation 137:2041-2051
Inohara, Taku; Shrader, Peter; Pieper, Karen et al. (2018) Association of of Atrial Fibrillation Clinical Phenotypes With Treatment Patterns and Outcomes: A Multicenter Registry Study. JAMA Cardiol 3:54-63
Thompson, Lauren E; Chan, Paul S; Tang, Fengming et al. (2018) Long-Term Survival Trends of Medicare Patients After In-Hospital Cardiac Arrest: Insights from Get With The Guidelines-Resuscitation®. Resuscitation 123:58-64

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