National Registry of CPR Mission. Cardiopulmonary Resuscitation NRCPR Why Bother? 1. What is NRCPR? NRCPR U.S.

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1 Mary Ann Peberdy, MD, FACC Associate Professor of Internal Medicine and Emergency Medicine Virginia Commonwealth University What is? Multi-facility registry Based on the In-Hospital Utstein document Consensus derived standardized definitions Allows aggregate data analysis Fulfills JCAHO requirements Identifies opportunities for improving resuscitation practice & outcomes Ongoing longitudinal source of data Who is? U.S. Participants American Heart Association Scientific Advisory Board Digital Innovation Hospital Participants You! CPR Mission To provide an efficient and consistent means for hospitals to collect and analyze resuscitation data, thereby equipping them to evaluate equipment and training, improve practices, and ultimately save lives Includes Process and Outcomes Research Mission Facilitate analysis (and dissemination) of high quality in-hospital resuscitation data to save lives locally and nationally Disseminate findings (timely and accurately) Oversight of data quality Oversight of data analysis (inquiry) Provide feedback to users Facilitate timely high quality publication of results Improve benchmarking of process and outcome of resuscitation Use data to implement advances in clinical care 1

2 Poorly Defined Nomenclature Utstein-style Definitions Many definitions of cardiac arrest Inconsistent time points Inconsistent outcomes successful resuscitation Ill defined co-morbidities Difficult to interpret any study Impossible to compare studies Resuscitation science must to progress from anecdotes and imprecise impressions to evidencebased medicine Rigorous data definitions Consistently reported data elements Data Quality & Completeness Designated local data entry persons Training CD Internet based certification exam Internal data checks within dataset Must complete sections Periodic global data re-abstraction NRPCR Process Patients entered into database are assigned a unique code HIPAA compliant Encrypted data submission via internet Data from individual patients and individual facilities are not released Quarterly data reports Benchmarking Data completeness reports Continuous oversight by SAB Other Activities Modules Monthly User s teleconference Annual User s meeting Web-based materials Timely science updates Cardiac Arrest Dataset 2000 current Versions 1 thru 5 MET Dataset January, 2006 currennt Post-Resuscitation Dataset To be released in Version 7 MET LOSC to ROSC Post Resus Care 2

3 Cumulative Cardiac Arrest Event Rate MET Dataset Gradual changeover to Version 5 85 hospitals have submitted V. 5 data 40 have a MET and have submitted data 25 are implementing MET 20 do not have MET All participants must switch to V.5 for the quarter ending July 21, 2006 Cardiac Arrest Dataset Core and supplementary data elements Facility data Patient demographics Pre-event data Event data Outcome data Annual User s Conference Prolonged response time intervals to a certain area of the hospital after hours Prolonged times to invasive airway management Higher event rate and mortality in one specific unit Refined data collection tools DATA IS POWER Survival Patterns by Time of Day Survival Patterns by Time of Day 3

4 What YOU Get For Your Effort : Enhancing the Value of MET Data broken down by location of events in the hospital and time of day DNAR and neurological outcome Numerical printouts and graphs of presenting rhythms, times to intubation and drug therapies, etc Process of care exceptions Benchmarking ability MET Module Literature review Collaboration with experts Final approval by SAB Parts of module Dataset Evidence based plus best clinical practice Sample documentation forms Data Abstraction Forms Operational Definitions Quarterly Reports MET Module Educational Process Electronic self-study guides Well-defined Operational Definitions On-line resources and FAQs User group conference calls and user conferences Clinical and technical support via phone or Software Help screens Support with report interpretation MET Module Reports Patient demographics Gender Race Age Discharge Disposition Event demographics Where When Illness category Pre-event indicators MET Module Reports MET Event Specific Event counts by day-time-location Triggers by location in hospital Outcomes Clinical Administrative Identify high risk patients Previous ICU, ED, recent anesthesia 4

5 Event Specific Report Data Event data by day - time location Triggers By location in hospital Outcomes Clinical Administrative Identify high risk patients Previous ICU, ED, anesthesia MET Module Reports Vital signs prior to the event Response time intervals Event duration Resource utilization drugs and equipment DNAR status Links to cardiac arrest data Comparative data It is time for data and information to replace anecdotes and impressions Provides measurable, standardized data on MET process and outcomes Decreases duplication of effort by providing information for multi-agency reporting Provides intra-facility and inter-facility comparison data Contributes to advancing the science Save lives! 5