EP Lab Digest - March 2008 - (Page 11)

MARCH 2008 COVER STORY 11 In addition, some people have speculated that practicing more mock code drills in hospitals might be helpful. This would be similar to how fire drills are practiced in schools, and knowing that when a real fire drill is called, people would know what to do. It is the same thing in a code setting; going through the motions on a regular routine basis — whether it is on a monthly or quarterly basis — and assessing what the problems or obstacles are will help to enhance efficiency and also defibrillation time. Therefore, I believe Dr. Saxon highlights one potential solution. We really do not yet know which one or combination of these solutions will ultimately make a difference in defibrillation times for patients. I think we need to take a step back before we consider suggesting that all hospitals should: 1) monitor all patients for cardiac arrest, which can be expensive, or 2) put AEDs in without knowing how cost effective and how frequently these codes occur on unmonitored unit settings. The reality is the majority of the arrests (about 80 to 85 percent) in our study occurred in settings such as the intensive care unit or the telemetry floor, so these patients were already being monitored. Therefore, it wasn’t a question of discovering that the patients were in cardiac arrest, it was getting the logistics of a defibrillator shock to them. Thus, it may be much more complex than one solution. Yes, the NRCPR hospitals have been doing an ongoing quality improvement. They receive quarterly feedback reports, and a number of them have also implemented rapid response teams that typically intervene before a patient suffers from cardiac arrest. In a rapid response team, a nurse or staff person calls this team because the patient is looking poorly and going for the worse.The members of this team come and evaluate the patient, and determine whether or not the patient needs intervention.The hope is that they can prevent a cardiac arrest from ever occurring, let alone improving their outcomes. A number of the NRCPR hospitals have implemented rapid response teams; we will be getting the information soon to look at whether or not they’ve had an impact. heading that study. I will also be looking at hospital level differences in defibrillation times. Ultimately we are considering how best to do interventions to see which of the things we discussed may potentially modify the times for defibrillation and hopefully affect overall survival rates. More information can be found at: N Engl J Med 2008;358:9-17. Will you be doing research on this topic? further Yes, I will be involved in the statistical analyses of the rapid response teams; one of the other task force members is Do you know if there were any hospitals that had significantly more problems than others? Or were there worse defibrillation times in particular areas of the U.S.? At the time of the analysis we had only very crude geographic markers, including four geographic regions (northeast, midwest, south, and west). We are obtaining more hospital information as we speak that is much more refined and will provide data on the economic status of the hospitals, the nurse-to-patient ratio, academic status, and whether or not the hospitals had AEDs available. We are looking at about 50 variables at each of the hospitals that we hope will ultimately identify which of these hospitals perform better and what the unique qualities were at these hospitals.We are particularly interested in knowing which hospitals with greater resources and academic affiliations perform better. Do you know if the hospitals included in this study will be making changes to improve patient survival? http://www.ascenths.com/cardiology http://www.ascenths.com/cardiology http://www.ascenths.com/cardiology

Table of Contents Feed for the Digital Edition of EP Lab Digest - March 2008

EP Lab Digest - March 2008 ECG 101: The Case of a Dizzy Patient with a Left Bundle Branch Block Delayed Defibrillation: Research and Results Interview with Paul S. Chan, MD Contents Letter from the Editor Spotlight Interview: St. Joseph’s Hospital Health Center Parent Heart Watch from 36,000 Feet… Perspectives from the Annual Leadership Conference Clinical Trial Overview: 2008 Are MRI-Safe Pacemakers and Leads on the Horizon? Q & A with J. Rod Gimbel, MD Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead Email Discussion Group: March 2008 Guidelines on ECG Interpretation Spotlight Interview Update: What Have We Learned? The Value of Educating Staff Events Calendar Industry News and Products Classifieds Advertisers Index In Memoriam

EP Lab Digest - March 2008

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