Hospitals with the highest rates of cardiac arrests tend to have the poorest survival rates for those cases, while hospitals that do the best job of preventing cardiac arrest among their patients tend to be better at saving patients with cardiac arrest, according to new research published in JAMA Internal Medicine.
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Lead author Lena M. Chen, MD, assistant professor in internal medicine at the University of Michigan, she and her fellow researchers at the University of Michigan Health System, identified hospitals in a national registry with at least 50 adult in-hospital cardiac arrest cases between Jan. 1, 2000 and Nov. 30, 2009. They used the data to evaluate the correlation between a hospital's cardiac arrest incidence rate and its case-survival rate after adjusting for patient and hospital characteristics.
Chen said in many ways the results were not what she and her fellow researchers were expecting. For conditions other than cardiac arrest, higher volume has been associated with better outcomes for patients. For example, for many procedures, hospitals and surgeons that perform more cases also have lower mortality rates.
"We found that if a hospital prevents cardiac arrest more often, they tend to do better at rescuing patients when they do have arrests, which is important for two reasons,' she said. "There are so many quality measures out there – does this mean we should report on incidences and the survival rates of those incidences as a quality measure? From the perspective of the patients and improving care, our results should be reassuring for those seeking to identify the best hospital in the area of cardiac arrest. Do these results also provide an additional clue for the best ways to prevent death?"
National efforts to improve the quality of hospital care for cardiac arrest have focused on measuring hospitals' cardiac arrest survival rates. Chen suggests that these efforts are an appropriate first step towards reducing mortality from cardiac arrest, since hospitals that have high case-survival rates are also likely to have low incidence rates.
She noted that while the study did not focus on the cost savings a hospital could achieve through the prevention of cardiac arrest and higher survival rates, "anything that prevents cardiac arrest from occurring in the first place would be extremely cost effective."
Chen said she could not fully explain why hospitals' performance on prevention and treatment seem to go hand-in-hand. The results suggest that some hospital factors, such as nurse staffing, may mediate the relationship between incidence and survival. For example, hospitals with higher nurse-to-bed ratios may have both lower rates of cardiac arrest and higher survival rates, the study found.
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She added that a next step in better prevention and treatment of cardiac arrest might be to interview the hospitals that did well in this study to examine what is behind their success.
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