S678 Circulation November 2 2010 by guest on

S678 circulation november 2 2010 by guest on

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S678 Circulation November 2, 2010 by guest on May 18, 2014 Downloaded from
sequence of CPR steps. Laypersons can learn these skills online and in courses. In contrast, in a highly specialized environment, such as a critical care unit of a hospital, many of the individual compo- nents of CPR (compression-ventilation-defibrillation) may be managed simultaneously. This approach requires choreog- raphy among many highly-trained rescuers who work as an integrated team. In the prehospital setting, the order of the CPR components performed by the healthcare provider may switch between a sequenced and choreographed model depending on the pro- ficiency of the provider and the availability of resources. Quality Improvement in Resuscitation Systems, Process, and Outcomes A Systems Approach Cardiac arrest is an important public health issue. Resus- citation involves a broad spectrum of individual stakehold- ers and groups. Individuals include victims, family mem- bers, rescuers, and healthcare providers. Key stakeholder groups include the public, emergency medical dispatchers, public safety organizations, EMS systems, hospitals, civic groups, and policy makers at the local, state, and federal levels. Because the links in the Chain of Survival are interde- pendent, an effective resuscitation strategy requires these individuals and groups to work in an integrated fashion and function as a system of care . 40 Fundamental to a successful resuscitation system of care is the collective appreciation of the challenges and opportunities presented by the Chain of Survival. Thus individuals and groups must work together, sharing ideas and information, to evaluate and improve their resuscitation system. Leadership and ac- countability are important components of this team approach. A conceptual appreciation of the system and its working components is only a starting point. Improving care requires assessment of performance. Only when perfor- mance is evaluated can participants in a system effectively Figure 3. Simplified Adult BLS Algorithm. Travers et al Part 4: CPR Overview S679 by guest on May 18, 2014 Downloaded from
intervene to improve care. This process of quality im- provement consists of an iterative and continuous cycle of (1) systematic evaluation of resuscitation care and out- come, (2) benchmarking with stakeholder feedback, and (3) strategic efforts to address identified deficiencies (see Figure 4). There is wide community and hospital variability in cardiac arrest survival. 3,8,13 High-performing systems have used this continuous quality improvement approach with great success, 41 as have systems that have more recently adopted this strategy. 42 These successes have occurred in a variety of systems, suggesting that all communities and hospitals can substantially improve care and outcomes. Since each system has different characteristics and chal- lenges, there is no single prescriptive strategy for improve- ment. However, each system has an obligation to address the fundamental principles of quality improvement: mea- surement, benchmarking, and feedback and change.

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