A new report that hints stress factors like case volume and academic status of a hospital do not explain the wide disparities in defibrillation response times in hospitals has at least one hospitalist convinced HM leaders can help solve the problem.
Traditional hospital pressures do not predict whether patients with cardiac arrest are likely to experience delays in receiving defibrillation, according to a July 27 report in the Archives of Internal Medicine (2009;169(14):1260-1261). Such factors as the number of beds and where the cardiac unit was located were found to have more impact, the study found.
“This is a very simple thing,” says hospitalist Jason Persoff, MD, FHM, assistant professor of medicine at the Mayo Clinic in Jacksonville, Fla. "What are the barriers to shocking the patient? This doesn’t require huge committees. The question is, 'Why isn’t this happening?' … This paper is a call to arms."
According to the study, rates of delayed defibrillation, which were defined as longer than the two-minute standard, ranged from 2.4% to 50.9%. The authors state that standardizing defibrillation times to meet the two-minute standard set by the American Hospital Association could be a quality initiative focus for HM groups.
“Now that we’ve identified the problem, that helps us identify how to move forward,” Dr. Persoff says. “We are in dire need of improving our system when it comes to cardiac care. The hospitalists are in the best position to do that because we are able to work closest with the nurses.”
Jane Kelly-Cummings, RN, CPHQ, SHM's senior director of quality initiatives, agrees there is room for improvement in the survival rate of in-hospital cardiac patients. "In order to make those improvements, hospitals will need to make changes to their cardiac resuscitation processes and procedures," she says. "Hospitalists are integral and central players on cardiac resuscitation teams at a great majority of hospitals with hospital medicine programs. They act as change agents at these and many other facilities."
For more information on HM's role in cardiac resuscitation of hospitalized patients, visit the Emergency Procedures section of the "Core Competencies in Hospital Medicine."a