Quality Improvement

The quality improvement process relies on valid measurements of resuscitation performance and patient outcome. Examples of core performance measures that can be evaluated in a SCA quality improvement plan include:

• Response times. The time required from receipt of the 911 call until arrival at patient.
• This is a measure that can be improved within the agency. Decreasing the time it takes to dispatch a crew to the scene can directly improve survival rates. All components of the response time should be reviewed. A plan to decrease delays should be developed and tested.
• Rate of bystander CPR.
• Bystander CPR rates can be improved by implementing effective dispatcher CPR instruction programs and by addressing community awareness and expectations regarding SCA and CPR through media campaigns, or educational activities and training.
• Time from the 911 call to first defibrillation.
• Once dispatch issues have been addressed as described previously, team configuration and skills training designed to emphasize the importance of early defibrillation can be implemented.
• Interruptions to chest compression during CPR.
• The CPR fraction is the percentage of time that compressions are being delivered during the resuscitation. This parameter should reach into the 90% range. Team skills training designed to minimize interruptions to compressions can be implemented using SCA scenarios. Airway and IV placement should be accomplished without major delays in compressions. The CPR fraction can be measured using downloads from the monitor/defibrillator, as well as data from skills training sessions using manikins that document these parameters.
• CPR quality and ventilation rate.
• If these parameters are not collected in the field, skills manikins and/or defibrillator/monitors with CPR accelerometers are available to allow evaluation and improvement in the practice of high quality CPR.
• Airway management:
• Success of airway management procedures should be documented and reviewed. Confirmation of airway placement should be confirmed at intubation, upon transport and upon arrival to the emergency department. Skills training using SCA scenarios can be used to address airway management issues.
• Documentation
• Complete documentation of events that occur during the resuscitation should be monitored.
• Survival to hospital discharge.
• Hospital discharge is the significant outcome measure and should be evaluated and reported on an annual basis.