Perceptions of resuscitation care among in-hospital cardiac arrest responders: a qualitative analysis

Abstract

Background: In-hospital cardiac arrests (IHCA) occur commonly and are associated with poor survival and variable outcomes. This study aimed to directly survey IHCA responders to understand their perceptions of resuscitation care. Methods: As part of a quality improvement initiative, we surveyed participating providers of IHCAs at our institution from Jan 2014 to May 2016. The survey included unstructured free text feedback, which was the focus of this study. We systematically coded the free text and organized identifiable latent themes using thematic analysis. We used the natural timeline of an IHCApre-arrest, arrest, and post-arrestfor organization of the identifiable latent themes, and created a separate category for holistic remarks that arched across the timeline. Results: We identified 172 IHCAs with a mean of 1.7 responses per arrest (range: 1-8 responses). The mean age of this patient population was 59 years at the time of arrest, and 107 (62%) were men. We identified several themes-[1] issues around code activation and code status characterized the pre-arrest period [2] ,team interactions and issues around supplies/equipment dominated the intra-arrest period, and [3] code cessation and transitions of care typified the post-arrest period. Holistic remarks focused on attentiveness paid by the arrest team to patient comfort and family. Some comments reflected positive experiences but most focused on areas of improvement consistent with the initiative's purpose. In certain cases, we identified a tension between the need to balance established resuscitation protocols with flexibility required by real-life circumstances. Conclusions: Directly surveying those who participated in IHCAs led to novel insights about their experiences. Our findings suggest that parsing through such qualitative feedback can help hospitals identify areas of improvement, modulate expectations, temper emotions, and refine protocols.

Effectiveness of team-focused CPR on in-hospital CPR quality and outcomes

“… 12 Additionally, a 2020 qualitative analysis aimed to address experiences of healthcare providers responding to IHCAs. 13 Much of the dissatisfaction revolved around issues achieving closed-loop communication and with role identification and associated responsibilities. 13 Another study by Nallamathu et al collected input from a diverse group of code responders pointed again to the struggle of communication and role delineation.…”

“… 13 Much of the dissatisfaction revolved around issues achieving closed-loop communication and with role identification and associated responsibilities. 13 Another study by Nallamathu et al collected input from a diverse group of code responders pointed again to the struggle of communication and role delineation. 14 The four common themes of top-performing facilities included: designated resuscitation teams, multidisciplinary teams with clear roles, closed-loop communication and respectful leaders, and mock-code training.…”

Rapid response system adaptations at 40 US hospitals during the COVID-19 pandemic

“…Crowd size has frequently been identified as a barrier to effective team functioning and, although it is best studied in out-of-hospital cardiac arrest, mechanical CPR has been associated with improved survival after IHCA. 8 , 9 , 10 , 11 More studies will be required to evaluate the consequences, intended and unintended, on changes made to the structure and function of IHCA and RRT teams during the COVID-19 pandemic.…”

Nurses’ Perception regarding Cardiopulmonary resuscitation in intensive care unit

“…Due to these emergency circumstances, success does not depend a lot on the performance of an individual provider as it is the comprehensive interactions of various providers and the system. (Mullangi et al, 2020). Nurses' Perception defined as the recognition and interpretation of information.…”