Earlier Initiation of Targeted Temperature Management for Out-of-Hospital Cardiac Arrest Patients: A Quality Improvement Project.

IF 1.4 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Quality Management in Health Care Pub Date : 2025-10-21 DOI:10.1097/QMH.0000000000000523

Amna Aijaz, Maria Riasat, Yousuf Aijaz Wahid, Saad Farooq, Lina Miyakawa, YoungIm Lee

{"title":"Earlier Initiation of Targeted Temperature Management for Out-of-Hospital Cardiac Arrest Patients: A Quality Improvement Project.","authors":"Amna Aijaz, Maria Riasat, Yousuf Aijaz Wahid, Saad Farooq, Lina Miyakawa, YoungIm Lee","doi":"10.1097/QMH.0000000000000523","DOIUrl":null,"url":null,"abstract":"Background: Targeted temperature management (TTM) is widely used for patients presenting with cardiac arrest for its neuroprotective effects and has been shown to improve neurological outcomes and survival. In keeping with the adage \"time is brain\" and per prior retrospective studies supporting earlier initiation of TTM, we conducted a quality improvement project to improve Door to TTM initiation time (DTT).Objectives: Our primary aim was to reduce DTT in patients who presented with Out-of-Hospital Cardiac Arrest (OHCA). Our secondary aims were to determine the factors for the delay in initiation of TTM, determine the knowledge and perspectives regarding TTM, address gaps in knowledge, and identify system issues to reduce time to TTM initiation.Methods: To assess knowledge and perspectives about TTM and any delays in initiation, a baseline survey of clinicians involved in the direct care of OHCA patients was conducted. A series of interventions followed after which a post-intervention survey was conducted.Results: Post-intervention there was an increased proportion of participants who had read the TTM protocol (but not significantly different) (69.1% vs 84.6%, P = .07) and a decreased proportion believed that TTM was initiated at a satisfactory time on eligible patients (54.4% vs 30.8%, P = .02). The mean DTT decreased sequentially from a baseline of 5.3 hours to 1 hour, post-interventions. The mean DTT among non-survivors (n = 21) was 5.51 (95% CL: 3.86-7.16) hours and the mean DTT among survivors (n = 6) was 2.58 (95% CL: 0.98-4.19) hours with a difference that was not statistically significant for a 5% level of significance at a P-value of .068.Conclusion: Our QI project interventions were successful in lowering the DTT for OHCA patients. Larger and longer studies are needed to study associations between TTM initiation time, and neurological and survival outcomes.","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Quality Management in Health Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QMH.0000000000000523","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Targeted temperature management (TTM) is widely used for patients presenting with cardiac arrest for its neuroprotective effects and has been shown to improve neurological outcomes and survival. In keeping with the adage "time is brain" and per prior retrospective studies supporting earlier initiation of TTM, we conducted a quality improvement project to improve Door to TTM initiation time (DTT).

Objectives: Our primary aim was to reduce DTT in patients who presented with Out-of-Hospital Cardiac Arrest (OHCA). Our secondary aims were to determine the factors for the delay in initiation of TTM, determine the knowledge and perspectives regarding TTM, address gaps in knowledge, and identify system issues to reduce time to TTM initiation.

Methods: To assess knowledge and perspectives about TTM and any delays in initiation, a baseline survey of clinicians involved in the direct care of OHCA patients was conducted. A series of interventions followed after which a post-intervention survey was conducted.

Results: Post-intervention there was an increased proportion of participants who had read the TTM protocol (but not significantly different) (69.1% vs 84.6%, P = .07) and a decreased proportion believed that TTM was initiated at a satisfactory time on eligible patients (54.4% vs 30.8%, P = .02). The mean DTT decreased sequentially from a baseline of 5.3 hours to 1 hour, post-interventions. The mean DTT among non-survivors (n = 21) was 5.51 (95% CL: 3.86-7.16) hours and the mean DTT among survivors (n = 6) was 2.58 (95% CL: 0.98-4.19) hours with a difference that was not statistically significant for a 5% level of significance at a P-value of .068.

Conclusion: Our QI project interventions were successful in lowering the DTT for OHCA patients. Larger and longer studies are needed to study associations between TTM initiation time, and neurological and survival outcomes.

查看原文本刊更多论文

院外心脏骤停患者早期启动目标温度管理：质量改进项目。

背景：靶向温度管理（TTM）因其神经保护作用被广泛应用于心脏骤停患者，并已被证明可改善神经预后和生存率。根据“时间就是大脑”的格言，并根据先前支持早期启动TTM的回顾性研究，我们进行了一个质量改进项目，以改善从门到TTM的启动时间（DTT）。目的：我们的主要目的是降低院外心脏骤停（OHCA）患者的DTT。我们的第二个目标是确定启动TTM延迟的因素，确定关于TTM的知识和观点，解决知识差距，并确定系统问题以减少启动TTM的时间。方法：对参与OHCA患者直接护理的临床医生进行基线调查，以评估关于TTM的知识和观点以及任何延迟启动。随后进行了一系列干预，之后进行了干预后调查。结果：干预后，阅读TTM方案的参与者比例增加（但无显著差异）（69.1% vs 84.6%, P = 0.07），认为在合适的时间开始TTM的比例下降（54.4% vs 30.8%, P = 0.02）。干预后，平均DTT从基线5.3小时依次下降到1小时。非幸存者（n = 21）的平均DTT为5.51 （95% CL: 3.86-7.16）小时，幸存者（n = 6）的平均DTT为2.58 （95% CL: 0.98-4.19）小时，差异无统计学意义，p值为0.068，显著性水平为5%。结论：我们的QI项目干预在降低OHCA患者的DTT方面是成功的。需要更大规模和更长期的研究来研究TTM起始时间与神经学和生存结果之间的关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

1.90

自引率

8.30%

发文量

108

期刊介绍： Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.