A cross-stakeholder approach to improving out-of-hospital cardiac arrest survival

Timothy C Guetterman; Jane Forman; Sydney Fouche; Kaitlyn Simpson; Michael D Fetters; Christopher Nelson; Peter Mendel; Antony Hsu; Jessica A Flohr; Robert Domeier; Rebal Rahim; Brahmajee K Nallamothu; Mahshid Abir

doi:10.1016/j.ahj.2023.09.004

A cross-stakeholder approach to improving out-of-hospital cardiac arrest survival

Am Heart J. 2023 Dec:266:106-119. doi: 10.1016/j.ahj.2023.09.004. Epub 2023 Sep 12.

Authors

Affiliations

¹ Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
² Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Qualitative and Mixed Methods Core, Center for Clinical Management Research, U.S. Department of Veterans Affairs, Ann Arbor, MI.
³ Acute Care Research Unit, University of Michigan, Ann Arbor, MI.
⁴ Acute Care Research Unit, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI.
⁵ Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI.
⁶ RAND Corporation, Santa Monica, CA.
⁷ Trinity Health Ann Arbor Hospital, Ann Arbor, MI.
⁸ Trinity Health Ann Arbor Hospital, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.
⁹ Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Skane University Hospital, Malmo, Sweden.
¹⁰ Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI.
¹¹ Acute Care Research Unit, University of Michigan, Ann Arbor, MI; RAND Corporation, Santa Monica, CA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI. Electronic address: mabir@rand.org.

PMID: 37709108
DOI: 10.1016/j.ahj.2023.09.004

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) affects over 300,000 individuals per year in the United States with poor survival rates overall. A remarkable 5-fold difference in survival-to-hospital discharge rates exist across United States communities.

Methods: We conducted a study using qualitative research methods comparing the system of care across sites in Michigan communities with varying OHCA survival outcomes, as measured by return to spontaneous circulation with pulse upon emergency department arrival.

Results: Major themes distinguishing higher performing sites were (1) working as a team, (2) devoting resources to coordination across agencies, and (3) developing a continuous quality improvement culture. These themes spanned the chain of survival framework for OHCA. By examining the unique processes, procedures, and characteristics of higher- relative to lower-performing sites, we gleaned lessons learned that appear to distinguish higher performers. The higher performing sites reported being the most collaborative, due in part to facilitation of system integration by progressive leadership that is willing to build bridges among stakeholders.

Conclusions: Based on the distinguishing features of higher performing sites, we provide recommendations for toolkit development to improve survival in prehospital systems of care for OHCA.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Cardiopulmonary Resuscitation* / methods
Emergency Medical Services*
Emergency Service, Hospital
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Quality Improvement
United States / epidemiology

Grants and funding

R01 HL137964/HL/NHLBI NIH HHS/United States