Implementation of a CPR quality data collection program in the emergency department: a quality improvement initiative.

Abstract

Objectives: We used quality improvement (QI) methodology to improve cardiopulmonary resuscitation (CPR) data collection within the emergency department (ED) for non-traumatic cardiac arrests. This novel program aimed to improve CPR data collection from a baseline of 48.7-80% between August 15th, 2023-April 14th, 2024.

Methods: The outcome measure was percentage of cases with CPR data available. The secondary measures included CPR rate and depth (composite measure), compression fraction, and CPR pauses < 10 s. Manual review of electronic health records and Zoll Case Review^© was utilized for data extraction. The project team was created utilizing a stakeholder matrix. Diagnostics included an Ishikawa diagram, QI huddles, simulation, and process mapping. Interventions included: introduction of an emergency medical services (EMS)-to-ED adapter, simulation and education, and data debriefing. Elements were introduced and tested with simulation prior to implementation. P-charts and x-charts were used to determine successful completion of aims.

Results: CPR data were available in 48.7% (19/39) of cardiac arrest cases during the baseline period (February 15th, 2023-August 14th, 2023). Special cause variation was met during the implementation period with a shift (≥ 8 consecutive points above or below median), improving data collection to 89.1% (49/55). Improvements were identified with a shift for CPR in target for rate and depth (1.8-20.4%) and compression fraction (82.2-86.9%). No special cause variation was identified for CPR pauses < 10 s.

Conclusion: Through the use of QI methodology, we successfully improved CPR data collection within our ED from 48.7-89.1% for non-traumatic cardiac arrests. Improvements were seen in CPR in target for rate and depth, and compression fraction. This program provides a foundation for reliable CPR performance measurement and improvement, and serves as an example for other ED's with similar interest in CPR performance improvement.