Changing the Culture to Improve CCF: An Improvement Project.
Prehospital Emergency Care · 2024-08-05 · Implementation & quality improvement
Abstract
OBJECTIVES: After identifying chest compression fraction (CCF) as a key area for improvement, our Emergency Medical Services (EMS) agency aimed to improve our baseline monthly median CCF from 81.5% to 90% or more in paramedic-attended medical cardiac arrests by December 2023. The CCF is a process measure that, if improved, has been shown to increase likelihood of survival from cardiac arrest. Working as a hospital EMS agency within a large urban 9-1-1 system, our interventions focused on paramedics once they arrived on scene. METHODS: This project used repeated Plan-Do-Study-Act (PDSA) cycles with brainstorming sessions, focus groups, and data review to achieve improvement. Interventions included standardized clinician feedback forms, increased follow-up for patients with ongoing resuscitation, a designated CPR team leader during resuscitations, and a pre-charged defibrillator prior to rhythm checks. These interventions were evaluated by tabulating weekly and monthly median CCF performance, seeking participant feedback, and reviewing control charts. These results were reported according to the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0). RESULTS: Our control chart analysis revealed special cause variation and an increase in average CCF to 89.0%. This improvement was achieved through successful implementation of process changes using PDSA cycles. Our most effective and popular intervention was our clinician feedback forms. Additionally, re-unifying patients and their successful resuscitation teams, participating in resuscitation academy events, and pre-charging the defibrillator to minimize CPR pauses collectively resulted in systemic improvement in resuscitation performance. CONCLUSIONS: The findings illustrate that targeted education, increased clinician feedback, patient-team reunification, and high-performance resuscitation strategies produce measurable improvement in CCF.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Implementation · Paramedics & EMTs · Urban
Related articles
- Self-Assessment Feedback Form Improves Quality of Out-of-Hospital CPR. (Prehosp Emerg Care, 2019)
- Implementation of a Prehospital Protocol Change For Asthmatic Children. (Prehosp Emerg Care, 2018)
- Trends in care processes and survival following prehospital resuscitation improvement initiatives for out-of-hospital cardiac arrest in British Columbia, 2006-2016. (Resuscitation, 2018)
- Educational outreach to improve emergency medical services systems of care for stroke in Montana. (Prehosp Emerg Care, 2010)
- Implementation of Pit Crew Approach and Cardiopulmonary Resuscitation Metrics for Out-of-Hospital Cardiac Arrest Improves Patient Survival and Neurological Outcome. (J Am Heart Assoc, 2016)
- Factors Impacting Treatment of Out-of-Hospital Cardiac Arrest: A Qualitative Study of Emergency Responders. (J Am Heart Assoc, 2023)