Hospital cardiac arrest resuscitation practice in the United States: A nationally representative survey

BACKGROUND In-hospital cardiac arrest (IHCA) outcomes vary widely between hospitals, even after adjusting for patient characteristics, suggesting variations in practice as a potential etiology. However, little is known about the standards of IHCA resuscitation practice among US hospitals. OBJECTIVE To describe current US hospital practices with regard to resuscitation care. DESIGN A nationally representative mail survey. SETTING A random sample of 1000 hospitals from the American Hospital Association database, stratified into 9 categories by hospital volume tertile and teaching status (major teaching, minor teaching, and nonteaching). SUBJECTS Surveys were addressed to each hospital's cardiopulmonary resuscitation (CPR) committee chair or chief medical/quality officer. MEASUREMENTS A 27-item questionnaire. RESULTS Responses were received from 439 hospitals with a similar distribution of admission volume and teaching status as the sample population (P=0.50). Of the 270 (66%) hospitals with a CPR committee, 23 (10%) were chaired by a hospitalist. High frequency practices included having a rapid response team (91%) and standardizing defibrillators (88%). Low frequency practices included therapeutic hypothermia and use of CPR assist technology. Other practices such as debriefing (34%) and simulation training (62%) were more variable and correlated with the presence of a CPR committee and/or dedicated personnel for resuscitation quality improvement. The majority of hospitals (79%) reported at least 1 barrier to quality improvement, of which the lack of a resuscitation champion and inadequate training were the most common. CONCLUSIONS There is wide variability among hospitals and within practices for resuscitation care in the United States with opportunities for improvement. Journal of Hospital Medicine 2014;9:353-357. (c) 2014 Society of Hospital Medicine