Improving Providers Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest Response

Abstract

Background How nontechnical factors such as inadequate role definition and overcrowding affect outcomes of in-hospital cardiac arrest (IHCA) is unknown. Using a bundled intervention, we sought to improve providers' role definitions and decrease overcrowding during IHCA events. Objectives To determine if a bundled intervention consisting of a nurse/physician leadership dyad, visual cues for provider roles, and a "role check" would lead to reductions in crowding and improve perceptions of communication and team leadership. Methods Baseline data on the number and type of IHCA providers were collected. Providers were asked to complete a postevent survey rating communication and leadership. A bundled intervention was then introduced. Data were then obtained for the subsequent IHCA events. Results Twenty ICHA events were captured before and 34 after the intervention. The number of physicians present at pulse checks 2 (median [interquartile range]: 6 [5-8] before vs 5 [3-6] after, P = .02) and 3 (7 [5-9] vs 4 [4-5], P = .004) decreased significantly after the intervention. The overall number of providers at the third pulse check (18 [14-22] before vs 14 [12-16] after, P = .04) also decreased after the intervention. On a 10-point Likert scale, ratings of communication (8 [7-8]) and physician leadership (8 [7-9]) did not differ significantly from before to after the intervention. Both the physician leads (90%) and patients' primary nurses (97%) were able to identify clear nurse leaders. Conclusion A bundled intervention targeted at improving IHCA response led to a decrease in overcrowding at ICHA events without substantial changes in the perceptions of communication or physician leadership.

Cardiopulmonary Resuscitation Training for Healthcare Professionals

“…13,14 Several aspects make IHCA more complex than out-ofhospital cardiac arrest as the in-hospital resuscitation team may not know each other when initiating resuscitation and many providers at the location increases the risk of overcrowding. 15 Moreover, IHCA is unpredictable and can occur anywhere in the hospital. Most cardiac arrests occur outside of the intensive care unit in many European countries, distributed across all hospital departments.…”

Findings from a tandem clinician leadership intervention for emergency department cardiac arrest care during the COVID-19 pandemic

“…The exact role of nursing personnel alongside physicians as team leaders during a CPA resuscitation is a matter of great clinical equipoise and debate [ [11] , [12] , [13] , [14] , [15] ]. Conventionally, physicians or APP's have held the roles of team leaders.…”

“…In correspondence with other academic ED's, this practice has sometimes been referred to as nurse led codes. To the best of our knowledge, there is scant to no formal literature on outcomes associated with nurse led codes in the ED setting and certainly not during pandemic settings [ [11] , [12] , [13] , [14] , [15] , [16] ]. This study will present the findings of an educational intervention on perceived knowledge and clinician comfort of a novel CPA protocol with joint physician and nursing leadership in an academic ED setting during the COVID-19 pandemic.…”

Exploring role clarity in interorganizational spread and scale-up initiatives: the ‘INSPIRED’ COPD collaborative

“…Role clarification is the process by which professionals develop a clear understanding of their roles and the roles of others and use this knowledge to achieve patient goals [3]. Role clarity is associated with improved care coordination and professional autonomy balanced with interdependence [4], while ambiguity about responsibilities can lead to conflict and tension [5][6][7], service duplications or gaps [5,8,9], and underutilization of professional expertise [1]. Recognition of role clarification as a valuable collaborative tool is reflected in growing opportunities for students in healthcare fields to develop this skill [10].…”