A smartwatch-based CPR feedback device improves chest compression quality among health care professionals and lay rescuers.

Background: Cardiopulmonary resuscitation (CPR) quality significantly impacts patient outcomes during cardiac arrests. With advancements in health care technology, smartwatch-based CPR feedback devices have emerged as potential tools to enhance CPR delivery. Objective: This study evaluated a novel smartwatch-based CPR feedback device in enhancing chest compression quality among health care professionals and lay rescuers. Methods: A single-center, open-label, randomized crossover study was conducted with 30 subjects categorized into 3 groups based on rescuer category. The Relay Response BLS smartwatch application was compared to a defibrillator-based feedback device (Zoll OneStep CPR Pads). Following an introduction to the technology, subjects performed chest compressions in 3 modules: baseline unaided, aided by the smartwatch-based feedback device, and aided by the defibrillator-based feedback device. Outcome measures included effectiveness, learnability, and usability. Results: Across all groups, the smartwatch-based device significantly improved mean compression depth effectiveness (68.4% vs 29.7%; P < .05) and mean rate effectiveness (87.5% vs 30.1%; P < .05), compared to unaided compressions. Compression variability was significantly reduced with the smartwatch-based device (coefficient of variation: 14.9% vs 26.6%), indicating more consistent performance. Fifteen of 20 professional rescuers reached effective compressions using the smartwatch-based device in an average 2.6 seconds. A usability questionnaire revealed strong preference for the smartwatch-based device over the defibrillator-based device. Conclusion: The smartwatch-based device enhances the quality of CPR delivery by keeping compressions within recommended ranges and reducing performance variability. Its user-friendliness and rapid learnability suggest potential for widespread adoption in both professional and lay rescuer scenarios, contributing positively to CPR training and real-life emergency responses.

Improving Accuracy in Documenting Cardiopulmonary Arrest Events.

PURPOSE: Traditional paper documentation of cardiopulmonary arrest (CPA) events is often inaccurate and incomplete. Electronic documentation supports appropriate process improvements and optimal patient care and contributes to greater accuracy in national databases from which national benchmarks are derived. The aim of this quality improvement initiative was to compare the timeliness and accuracy of paper-based versus electronic documentation of live CPA events. METHODS: Nurses on four medical-surgical pilot units received training on the use of a handheld electronic device with a documentation app (Full Code Pro) to document live CPA events. The data were downloaded into an Excel file and compared for completeness and accuracy with the data downloaded from the LIFEPAK 15 defibrillator using CODE-STAT 10.0 software. Electronic documentation and traditional paper documentation of events from units where the intervention wasn't implemented (control units) were also compared with the CODE-STAT data. RESULTS: There were 26 CPA events: six on the pilot units were documented using the electronic app, 12 on the pilot units were documented using the paper-based method (the latter were excluded from analysis), and eight on the control units were documented using the existing paper forms. Data accuracy was significantly greater in the electronic group compared with the paper-based group for recorded rhythm (100% versus 13%, P = 0.01) and end-tidal carbon dioxide (67% versus 0%, P = 0.02). The electronic method significantly outperformed the paper-based method in legibility (100% versus 13%, P < 0.01). Staff reported increased satisfaction with the electronic documentation method. CONCLUSION: Using electronic handheld devices to document live resuscitation events demonstrated the inaccuracies of paper-based documentation, supporting the findings of previous studies. Electronic documentation was superior to paper in overall documentation quality and allowed providers to identify and quickly document the initial rhythm of the event. A larger study using electronic documentation to capture more ventricular fibrillation and ventricular tachycardia arrests would show a greater accuracy of timing, which would have large positive effects on overall resuscitation quality.

Flexibility in a Crisis: How Strong Relational Coordination and Lean Literacy Helped Us Weather the COVID Storm.

Our city was significantly impacted by the initial COVID-19 outbreak in the United States. We describe how members of our Quality and Safety team were able to leverage skills in relational coordination and process improvement to respond to rapidly changing needs in a flexible and effective way.

CE: A Prone Positioning Protocol for Awake, Nonintubated Patients with COVID-19.

ABSTRACT: Prone positioning of critically ill patients with acute respiratory distress syndrome is an accepted therapy done to improve oxygenation and promote weaning from mechanical ventilation. But there is limited information regarding its use outside of the ICU. At one Boston hospital, the influx of patients with suspected or confirmed COVID-19 strained its resources, requiring sweeping systems changes and inspiring innovations in clinical care. This article describes how an interdisciplinary team of clinicians developed a prone positioning protocol for use with awake, nonintubated, oxygen-dependent patients with suspected or confirmed COVID-19 on medical-surgical units, with the hope of hastening their recovery and avoiding deterioration and ICU transfer. A protocol implementation plan and staff educational materials were disseminated via the hospital incident command system and supported through daily leadership huddles. Patient eligibility criteria, including indications and contraindications, and a clear nursing procedure for the implementation of prone positioning with a given patient, were key elements. Nurses' feedback of their experiences with the protocol was elicited through an e-mailed survey. Nearly all respondents reported improvements in patients' oxygen saturation levels, while few respondents reported barriers to protocol implementation. The prone positioning protocol was found to be both feasible for and well tolerated by awake, nonintubated patients on medical-surgical units, and can serve as an example for other hospitals during this pandemic.

Red blood cell use outside the operating theater: a prospective observational study with modeling of potential blood conservation during severe blood shortages.

BACKGROUND: National guidance recommends planning for future blood shortages, but few studies have evaluated how reduced demand could be achieved acutely. STUDY DESIGN AND METHODS: A trained observer collected data concerning red blood cell (RBC) transfusion events outside the operating theater during 68 hours of blood bank monitoring over 7 weeks. Data were gathered at the patients' bedside from clinical staff and charts. Transfusions were classified according to the presence of bleeding and medical specialty (medical, surgical, other). Hemoglobin (Hb) transfusion triggers, RBCs transfused, and posttransfusion Hb values were collected. Evidence-based scenarios were used to model the potential RBC savings that could be achieved if acute shortages occurred, incorporating ischemic heart disease as a potential decision modifier. RESULTS: A total of 83 patients received 100 transfusion events, comprising 207 RBC units, during the sampling periods. The relative use of RBC units across specialties was as follows: medical, 74%; surgical, 22%; and other, 4%. For medical and surgical patients, respectively, 31 and 10% of all RBC units were transfused for anemia without evidence of bleeding, and 38 and 12% were transfused for non-life-threatening bleeding. Eight-five percent of all patients who received transfusions had stable vital signs before transfusion. Our model suggested that only 11% of RBCs would be conserved by cancellation of major surgery, whereas 23% to 47% of all RBCs could be conserved by controlling transfusions to medical patients. CONCLUSION: In institutions with patterns of blood use similar to ours, control of transfusions to medical patients is the most effective response to acute blood shortages.