■小儿心脏重症监护联盟(PC4)心脏骤停预防(CAP)质量改进(QI)项目促进了多个医院的院内心脏骤停(IHCA)发生率降低。这一结果的可持续性尚未确定。
■在QI项目结束后,检查参与医院的IHCA发病率,并辨别哪些因素与持续改善最吻合。
这项观察性队列研究比较了CAP时代(2018年7月1日至2019年12月31日)的IHCA数据与2年随访时代(2020年3月1日至2022年2月28日)的数据。数据来自17家PC4CAP参与医院的儿科心脏重症监护病房(CICU)。
■CAP实践捆绑包旨在促进本地实践整合,为了实施,适应,并在CAP时代之后继续CAP流程。项目结束后2年进行了一项基于网络的调查,以估计CAP特定的QI工作。
■在研究阶段之间比较了所有入院患者的风险调整后IHCA发病率。这项调查产生了一个新的针对医院的QI可持续性评分,这通常反映了所执行的本地CAP工作的总和。
■在13082个CAP时代入院和16284个随访入院之间,人口统计学和入院特征没有临床上重要的差异(总平均[SD]年龄,5.1[8.4]岁;男性占56.1%)。风险调整后的IHCA发病率在CAP和随访者之间没有差异(2.8%对2.8%;比值比,1.03;95%CI,0.89-1.19),建议持续预防改进。医疗中风险调整后的IHCA发病率之间也没有差异,外科,或高风险亚组。在随访中,较低的医院QI可持续性评分与较高的IHCA几率相关(相关系数,-0.58;P=.02)。在随访时代,五家医院的风险调整后的IHCA率增加了1%或更高;这些医院的QI可持续性评分明显较低,并且在CAP时代采用可持续性要素的可能性较小,或者在随访期间报告持续参与CAP相关的QI流程。
■在这项17家医院的allCICU入院队列研究中,IHCA预防是可行和可持续的;在CAP项目结束后,经风险调整的IHCA比率的既定降低保持了至少2年。在后续行动期间,实施战略和继续参与CAP流程都与持续改进有关。
UNASSIGNED: The Pediatric Cardiac Critical Care Consortium (PC4) cardiac arrest prevention (CAP) quality improvement (QI) project facilitated a decreased in-hospital cardiac arrest (IHCA) incidence rate across multiple hospitals. The sustainability of this outcome has not been determined.
UNASSIGNED: To examine the IHCA incidence rate at participating hospitals after the QI project ended and discern which factors best aligned with sustained improvement.
UNASSIGNED: This observational cohort study compared IHCA data from the CAP era (July 1, 2018, to December 31, 2019) with data from the 2-year follow-up era (March 1, 2020, to February 28, 2022). Data were obtained from pediatric cardiac intensive care units (CICUs) from 17 PC4 CAP-participating hospitals.
UNASSIGNED: The CAP practice bundle was designed to facilitate local practice integration, with the intention to implement, adapt, and continue CAP processes beyond the CAP era. A web-based survey was administered 2 years after the end of the project to estimate CAP-specific QI work.
UNASSIGNED: Risk-adjusted IHCA incidence rates across all admissions were compared between study eras. The survey generated a novel hospital-specific QI sustainability score, which is generally reflective of the sum of local CAP work performed.
UNASSIGNED: There were no clinically important differences in demographic and admission characteristics between the 13 082 CAP era admissions and 16 284 follow-up admissions (total mean [SD] age, 5.1 [8.4] years; 56.1% male). Risk-adjusted IHCA incidences were not different between the CAP vs follow-up eras (2.8% vs 2.8%; odds ratio, 1.03; 95% CI, 0.89-1.19), suggesting sustained prevention improvement. There was also no difference between eras in risk-adjusted IHCA incidence within medical, surgical, or high-risk subgroups. A lower hospital QI sustainability score was correlated with higher odds for IHCA in the follow-up vs CAP era (correlation coefficient, -0.58; P = .02). Five hospitals had increases of 1% or greater in risk-adjusted IHCA rates in the follow-up era; these hospitals had significantly lower QI sustainability scores and were less likely to have adopted sustainability elements during the CAP era or report persistent engagement for CAP-related QI processes during follow-up.
UNASSIGNED: In this cohort study of all CICU admissions across 17 hospitals, IHCA prevention was feasible and sustainable; the established reduction in risk-adjusted IHCA rate was maintained for at least 2 years after the end of the CAP project. Both implementation strategies and continued engagement in CAP processes during the follow-up era were associated with sustained improvement.