The quality improvement process relies on valid measurements of resuscitation performance and patient outcome. Examples of core performance measures that can be evaluated in a SCA quality improvement plan include:
The time required from receipt of the 911 call until the arrival to the patient.
- This is a measure that can be improved within the agency. Decreasing the time it takes to dispatch a crew to the scene can directly improve survival rates. All components of the response time should be reviewed. A plan to decrease delays should be developed and tested.
Rate of bystander CPR
- Bystander CPR rates can be improved by implementing effective dispatcher CPR instruction programs, and by addressing community awareness and expectations regarding SCA and CPR through media campaigns or educational activities and training.
Time from the 911 call to first defibrillation
- Once dispatch issues have been addressed as previously described, team configuration and skills training designed to emphasize the importance of early defibrillation can be implemented.
Interruptions to chest compression during CPR
- The CPR fraction is the percentage of time that compressions are being delivered during the resuscitation. This parameter should reach into the 90% range. Team skills training designed to minimize interruptions to compressions can be implemented using SCA scenarios. Airway and IV placement should be accomplished without major delays in compressions. The CPR fraction can be measured using downloads from the monitor/defibrillator as well as data from skills training sessions using manikins that document these parameters.
Calculating Annual System Statistics from Registry Data
- Total Out-of-Hospital Cardiac Arrest (OHCA) Incidence (#/100,000)
- (Cases per 100,000 population)
- Population of the area served by the EMS system (#)
- (To enable incidence calculation)
- Total (all cases) OHCA Survival to Hospital Discharge (%)
- Presumed OHCA etiology (%)
- (% cardiac, % trauma, % respiratory, % drowning, % electrocution, % other)
- VF Incidence (#/100,000)
- (VF cases per 100,000 population)
- VF Survival to Hospital Discharge (%)
- (# VF survivors/# cases presenting in VF)
- CPR response (%)
- (Bystander, Family member, Fire/Police, EMS, medical provider, other)
- AED used (%)
- (Yes, No, Present but not used, AED malfunctioned) (%)
- ROSC in the prehospital setting (time, %)
- (Time ROSC began or No ROSC) ROSC upon Hospital Arrival (%)
- EMS Induced Hypothermia (Yes, No) (%)
- (Number of patients eligible for the prehospital therapeutic hypothermia (TH) therapy divided by the number of patients who received pre-hospital TH).
- Definition: Pre-hospital TH eligible patients are those who have achieved sustained ROSC but who remain unconscious in the pre-hospital setting.
- Hospital induced hypothermia (Yes, No) (%)
- (Number of patients eligible for in-hospital TH therapy divided by number receiving in-hospital TH) In-hospital eligible patients = those remaining unconscious but who have achieved ROSC and do not have contraindications to TH therapy).
- Overall Cerebral Performance Category score of 1-2 (%)
CPR quality and ventilation rate
- If these parameters are not collected in the field, skills manikins and/or defibrillators/monitors with CPR accelerometers are available to allow evaluation and improvement in the practice of high quality CPR.
- Success of airway management procedures should be documented and reviewed. Confirmation of airway placement should be confirmed at intubation, upon transport and upon arrival to the emergency department. Skills training using SCA scenarios can be used to address airway management issues.
- Complete documentation of events that occur during the resuscitation should be monitored.
Survival to hospital discharge
- Hospital discharge is the significant outcome measure and should be evaluated and reported on an annual basis.