Using Get With The Guidelines -Resuscitation Data to Impact Care

Transcription

1 Using Get With The Guidelines -Resuscitation Data to Impact Care Wednesday April 6, Q&A Contact Information for our Presenters: Odette Comeau (409) oycomeau@utmb.edu Keith Ozenberger (409) kaozenbe@utmb.edu Paul Chan, MD paulchan.mahi@gmail.com University of Texas Medical Branch-Galveston Do you have a mock code checklist, briefing / debriefing, tools or audit tool that you can share? Our debriefing process immediately post code is still a work in progress. We have a mock code checklist; feel free to Odette Comeau and she can send it to you. What are your code volumes per month for entry in registry? For the year 2015, we submitted 90 events into the registry. 1 P a g e

2 Do you have a dedicated staff person who enters data into your internal spreadsheets and also into the GWTG database? Yes- our dedicated staff person is Keith Ozenberger- one of the webinar presenters. How do you determine how many staff you need to dedicate to abstracting data? So far, our process has worked with Keith as the sole individual to enter data How you overcome lack of documentation of the event or no documentation? Those cases are referred to the appropriate individual and /or quality committee for follow-up. What barriers and successes have you had transferring documentation to your EMR? We utilize EPIC, and have been successful with many types of documentation builds. Our biggest challenge is the volume of new projects which then requires new requests to be placed into a queue. Are the managers supportive of ensuring the mock codes are done when scheduled? Our managers are very supportive overall. A message is sent out to volunteer their units. Some managers volunteer more often than others, however. Are your mock codes interdisciplinary with RNs and Physicians? Yes- they are multidisciplinary; this has included participation by our physicians in the past year. How did you get the physicians on board with the mock codes? 2 P a g e

3 We are an academic medical center. The physicians who primarily participate in adult mock codes are medicine residents; this is supported by the chief residents. For pediatric codes, the pediatric residents participate and this is supported by the medical director for the inpatient pediatric units. Our hospital struggles with the post code huddle, what suggestions do you have to make them run more smoothly? We struggle with the same; we too would love to hear from organizations who have been successful in the implementation of a debriefing immediately post code. Will the code sheets developed by UTMB be shared on the GWTG site? You may contact Odette Comeau; she can send them to you. When you do your feedback to staff and providers, how do you present the material? Staff meetings, s, dedicated meeting, etc.? It depends on the type of feedback and to whom. Sometimes the feedback is formal (formal quality referral); sometimes informal (1 on 1 conversation). Meetings are also utilized when appropriate; examples include nursing staff meetings and/or resuscitation committee. Did you participate in the mock code or did you observe and then evaluate for improvement and debrief? Yes; mock codes are facilitated and conducted by our staff in the Education Lab. A debriefing is part of the process. 3 P a g e

4 Paul Chan, MD Does the American Heart Association keep data for the post cardiac surgery patients? GWTG-R collects information as to whether the patients are admitted for a surgical reason vs. a medical illness reason, and whether the major admission reason was cardiac surgery (Illness Category variable). What we cannot ascertain was whether the arrest occurred post0-surgery, although one can reasonably infer that if the Illness Category variable is labeled "Surgery-Cardiac", the surgery has already occurred. Otherwise, if it was pre-op, I would assume it would be 'Medical-Cardiac" until surgery What are the current Get With The Guidelines-Resuscitation in-hospital survival rates for in-hospital arrests from the registry? Over the last 2 years, the risk-standardized survival rates have ranged between 23% to 25% for all cardiac arrest rhythms. However, I would not compare that using your hospital's unadjusted (raw) rate. You can download your hospital's risk-standardized rate on the online link Do you present CPA outside ICU survival to discharge vs ICU CPA survival to discharge? Currently, we do not report risk-standardized survival rates by ICU vs. non-icu, as it would require developing separate new models for both populations Is there any consideration to remove the cath lab patient population out of the bucket? Our physicians feel that some patients, not all, but some during procedure who experience Vfib and quickly get shocked and move on with the case can inflate the denominator and outcomes to appear better than they are compared to the true cases on the inpatient floors. That is technically true if one only looks at the unadjusted (raw) survival rate. The risk-standardized survival rate adjusts for where the arrests occurred, including the procedural areas (which have a higher survival rate). The risk-standardized survival rate is found on the online link. Do you believe that there will be issues with code operations efficiencies or teamwork now that the new 2015 BLS / ACLS guidelines are being implemented? For example, new hired staff will be taught the new guideline. Our hospital has not brought the rest of the staff up to speed on this. What are your thoughts about this disconnection in knowledge? Any recommendations for getting everyone on the same page? 4 P a g e

5 This is always an issue with updated guidelines. The process measures for Recognition have not changed significantly though, and the survival remains the ultimate outcome of interest, which has not changed. Each hospital will address this differently, but bringing this up with hospital leadership and administration is critical to endure a more seamless transition. I do not have formal recommendations as to how best to disseminate this to hospital staff who were trained before the new guidelines, but developing short bullets of the major changes and reiterating these over and over again throughout the hospital will be most useful 5 P a g e