Ingrid Frydson, MD
Resident
Children's Hospital of San Antonio, United States
Disclosure information not submitted.
Niveditha Balakumar, MBBS
Assistant Professor
Children's Hospital of San Antonio, United States
Disclosure information not submitted.
Donna Doerr, RN
Nurse Educator
The Children's Hospital of San Antonio, United States
Disclosure information not submitted.
Karma Barot, BS
Research Student
Eastern Virginia Medical School, United States
Disclosure information not submitted.
Utpal Bhalala, MD, , FCCM
Pediatric Intensivist, Associate Professor, Research Advisor
Driscoll Children's Hospital
Corpus Christi
Disclosure information not submitted.
Title: Impact of Quality Improvement Bundle on Compliance with Resuscitation Guidelines in Children
Introduction:
Various quality improvement (QI) interventions have been individually assessed for quality of cardiopulmonary resuscitation (CPR). We aimed to assess QI bundle (hands-on training and debriefing) for quality of CPR in our children’s hospital. We hypothesized that QI bundle improves quality of CPR in hospitalized children.
Methods:
We initiated a QI bundle (hands-on training and debriefing) in August 2017. We conducted a before-after analysis comparing the CPR quality during July 2013-May 2017 (before) and January 2018-December 2020 (after). We collected data from the critical events logbook on CPR duration, chest compressions (CC) rate, ventilation rate (VR), timing of first epinephrine, blood pressure (BP), end-tidal CO2(EtCO2) and vital signs monitoring during CPR. We performed univariate analysis and presented data as median interquartile range (IQR) and in percentage as appropriate. We compared the groups using Chi-Square test (significant p< 0.05).
Results:
We compared data from 58 CPR events versus 41 CPR events before and after QI bundle implementation respectively. The median (IQR) CPR duration for pre- and post-QI bundle were 5 (1-13) minutes and 3 minutes (1.25, 10) and timing of first dose of epinephrine were 2 (1, 2) minutes and 2 minutes (1, 5) respectively. We observed a significant improvement in compliance with CC rate (100-120 per minute) from 72% events before versus 100% events after QI bundle implementation (p=0.0009). Similarly, there was a significant decrease in hyperventilation from 100% events before versus 63% events after QI bundle implementation (p< 0.00001). We also observed improvement in monitoring of quality metrics (from 58% before versus 68% after for ETCO2 monitoring, p=0.3 and 14% before versus 39% after for BP monitoring, p=0.004) during CPR.
Conclusions:
Our QI bundle (hands-on training and debriefing) was associated with improved compliance with high-quality CPR in children.