Adherence to Recommended Guidelines Improves Acute Cardiac Care
Significant improvements in acute patient care are seen in hospitals that participate in large, quality-improvement registries.
-- by Joann Jovinelly
In a new study published this week in the New England Journal of Medicine, both survival and positive neurological outcomes have “significantly improved” in hospitals that participated in national quality improvement registries over the last decade. Using conservative estimates, that statistical improvement is about 9 percent of additional lives saved when comparing data from 2000 to 2009.
According to the study, hospitals participating in national quality improvement registries instituted special training for both medical and nonmedical personnel. This training included such tasks as learning how to properly use defibrillation equipment, staging “mock” cardiac arrests, and defining clear guidelines for post-resuscitation debriefings (that is, communicating clearly to other medical staff about a patient’s most recent status).
The Expert Take
In their 2005 award-winning book, The Gold Standard, authors Stefan Timmermans and Marc Berg explained how, for the first time, epidemiological data was applied across national guidelines when it came to critical cardiac procedures. The guidelines for these procedures, the authors explained, have only been systematically examined since the 1990s.
Prior to 1991, for instance, “epidemiological researchers looking at different survival rates could not compare them because no consensus existed about what counted as a true resuscitative effort. The difference between one percent and 33 percent could be explained by varying methodological approaches, terminological and conceptual inconsistencies, the different emergency medical systems, demographic variations, the efficiency of CPR [cardiopulmonary resuscitation] administration, or the quality of resuscitative efforts.”
This new epidemiological study demonstrates that adherence to standardized treatment guidelines for resuscitation care, as well as participation in quality improvement registries, appears to have significantly improved patient outcomes as far as neurologic function and survival rate.
Source and Method
For the 2012 study, researchers first identified all adults who had in-hospital cardiac arrests at 374 hospitals participating in the Get with the Guidelines-Resuscitation Registry between 2000 and 2009. They then examined those same results against temporal trends in risk-adjusted rates of survival to discharge.
What they found was that “risk-adjusted rates of survival to discharge increased from 13.7 percent in 2000 to 22.3 percent in 2009.” That is a 8.6 percent improvement in both “acute resuscitation survival and post-resuscitation survival” or an additional 17,000 surviving patients in every 200,000 between 2000 to 2009.
Epidemiological studies that examine the results of adherence to more systematic and consistent treatment guidelines can offer valuable information.
In this case, both survival and neurological outcomes after in-hospital cardiac arrests have improved in hospitals that participated in a national quality improvement registry. This is one example of how epidemiological research can lead to direct procedural changes that may prove critical in the fight to save lives.
Similar increases in risk-adjusted survival rates after in-hospital cardiac events were reported in other studies, such as this one, which was published in 2012 in the Journal of the American Medical Association.
In this study, increases in survival were at least partially attributed to a concentration on areas of weakness noted in epidemiological studies that identified areas in need of improvement, such as “delays in defibrillation” and “off-hours or unwitnessed [cardiac] arrests.” In those cases, suggestions for improving survival included offering better/remote intensive care unit monitoring and using automated external defibrillators.
Another 2012 study, this one published in The Lancet, also suggested streamlining acute care. This study suggested standardizing resuscitation procedures in order to develop minimum duration guidelines related to resuscitation attempts, a period that still varies greatly between hospitals.