Clinician Perspectives Regarding In-Hospital Cardiac Arrest Resuscitation: A Multicenter Survey

Abstract

Objectives: Evaluate clinicians’ sentiments about participating in cardiac arrest resuscitations and identify factors associated with confidence in resuscitation of cardiac arrest. Design: Electronic survey. Setting: Twenty-one hospitals in Utah and Idaho. Subjects: All attending physicians, residents, and nurses in a multilevel healthcare system likely to participate in an in-hospital cardiac arrest resuscitation at least once every 2 years. Interventions: None. Measurements and Methods: A survey instrument evaluating clinician perceptions of in-hospital cardiac arrest resuscitation participation was developed after literature review and iteratively revised based on expert input and cognitive pretesting. Survey responses were collected anonymously. Sixty percent of 1,642 contacted clinicians (n = 977) submitted complete responses, of whom 874 met study inclusion criteria (190 attending physicians, 576 nurses, and 110 residents). Most respondents (74%) participated in less than or equal to six in-hospital cardiac arrest events per year, and 41% of respondents were most likely to participate in in-hospital cardiac arrest resuscitation at a community, rural, or critical access hospital. Confidence in in-hospital cardiac arrest participation was high overall (92%), but lower among residents (86%) than nurses (91%) or attending physicians (96%; p = 0.008). Fewer residents (52%) than nurses (73%) or attending physicians (95%; p < 0.001) reported feeling confident leading in-hospital cardiac arrest teams. Residents (63%) and attending physicians (36%) were more likely to worry about making errors during an in-hospital cardiac arrest event than nurses (18%; p < 0.001). Only 15% of residents and 50% of respondents overall reported they were both confident participating in in-hospital cardiac arrest resuscitation and did not worry about making errors. In-hospital cardiac arrest participation frequency was the dominant predictor of respondents’ confidence leading or participating in an in-hospital cardiac arrest resuscitation. Conclusions: Many clinicians, especially residents, who participate in or lead in-hospital cardiac arrest resuscitation events lack confidence or worry about management errors. Hospitals—particularly smaller hospitals—should consider methods to provide in-hospital cardiac arrest teams additional “effective experience,” potentially using simulation or telemedicine consultation.

Relationship Between Resuscitation Team Members’ Self-Efficacy and Team Competence During In-Hospital Cardiac Arrest

“…After simulation completion, each participant was invited to complete a survey (7–9) evaluating contributors to resuscitation self-efficacy ( Appendix 1 , http://links.lww.com/CCX/B291). Respondents provided demographic data and ranked their agreement with each of three statements on a 5-point Likert-style scale: 1) “I felt confident in my role on the Code Blue team,” 2) “I had difficulty thinking clearly,” and 3) “I worry that I made errors.” The primary exposure was participant confidence in their resuscitation team role (“agree” or “strongly agree” response to the corresponding survey question).…”

Nurses as essential members of an effective in-hospital cardiac resuscitation team

“…Further research is needed to elucidate the role of other healthcare team members, such as the pharmacist and support staff who participate during the management of IHCA. The roles and impact of various medical professionals in the prevention of IHCA, prompt treatment response, and post-event care need to be better defined to appreciate the full picture of the healthcare team in improving outcomes after an IHCA event (9,10). This is important in view of numerous studies demonstrating that improving care of patients at risk of IHCA events begins with prevention.…”

“…Hospital staff, including nurses, pharmacists, and physicians must be adequately educated and properly trained to deliver the best possible care in team environments (11). Once return of spontaneous circulation is achieved, post-cardiac arrest care should be initiated quickly to establish hemodynamic and neurologic stability (1,9). The Institute of Medicine (11) has suggested an effort to standardize training and performance-evaluation measures for cardiac arrest treatment to promote a more rapid and uniform adoption and assessment of high-quality care on a national scale.…”