RESUMO
Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines.
Assuntos
Reanimação Cardiopulmonar/normas , Parada Cardíaca/terapia , Consenso , Tratamento de Emergência/normas , Guias como Assunto , Parada Cardíaca/tratamento farmacológico , Humanos , Vasoconstritores/uso terapêuticoAssuntos
Reanimação Cardiopulmonar/normas , Doenças Cardiovasculares/terapia , Serviços Médicos de Emergência/normas , Biomarcadores/metabolismo , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/métodos , Desfibriladores , Ecocardiografia , Humanos , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/normas , Parada Cardíaca Extra-Hospitalar/terapia , Choque Séptico/terapiaRESUMO
The process for evaluating the resuscitation science has evolved considerably over the past 2 decades. The current process, which incorporates the use of the GRADE methodology, culminated in the 2015 CoSTR publication, which in turn will inform the international resuscitation councils' guideline development processes. Over the next few years, the process will continue to evolve as ILCOR moves toward a more continuous evaluation of the resuscitation science.
Assuntos
Reanimação Cardiopulmonar/normas , Consenso , Serviços Médicos de Emergência/normas , Medicina Baseada em Evidências , Parada Cardíaca/terapia , Guias de Prática Clínica como Assunto , Viés , Reanimação Cardiopulmonar/métodos , Emergências , Serviços Médicos de Emergência/métodos , Humanos , Estudos Observacionais como Assunto , Projetos de PesquisaRESUMO
PURPOSE: A3 problem solving is part of the Lean management approach to quality improvement (QI). However, few tools are available to assess A3 problem-solving skills. The authors sought to develop an assessment tool for problem-solving A3s with an accompanying self-instruction package and to test agreement in assessments made by individuals who teach A3 problem solving. METHODS: After reviewing relevant literature, the authors developed an A3 assessment tool and self-instruction package over five improvement cycles. Lean experts and individuals from two institutions with QI proficiency and experience teaching QI provided iterative feedback on the materials. Tests of inter-rater agreement were conducted in cycles 3, 4 and 5. The final assessment tool was tested in a study involving 12 raters assessing 23 items on six A3s that were modified to enable testing a range of scores. RESULTS: The intraclass correlation coefficient (ICC) for overall assessment of an A3 (rater's mean on 23 items per A3 compared across 12 raters and 6 A3s) was 0.89 (95% CI 0.75 to 0.98), indicating excellent reliability. For the 20 items with appreciable variation in scores across A3s, ICCs ranged from 0.41 to 0.97, indicating fair to excellent reliability. Raters from two institutions scored items similarly (mean ratings of 2.10 and 2.13, p=0.57). Physicians provided marginally higher ratings than QI professionals (mean ratings of 2.17 and 2.00, p=0.003). Raters averaged completing the self-instruction package in 1.5 hours, then rated six A3s in 2.0 hours. CONCLUSION: This study provides evidence of the reliability of a tool to assess healthcare QI project proposals that use the A3 problem-solving approach. The tool also demonstrated evidence of measurement, content and construct validity. QI educators and practitioners can use the free online materials to assess learners' A3s, provide formative and summative feedback on QI project proposals and enhance their teaching.
Assuntos
Instalações de Saúde , Melhoria de Qualidade , Atenção à Saúde , Humanos , Resolução de Problemas , Reprodutibilidade dos TestesAssuntos
Reanimação Cardiopulmonar/educação , Serviços Médicos de Emergência/normas , Medicina de Emergência/educação , Parada Cardíaca/terapia , Suporte Vital Cardíaco Avançado/educação , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Instrução por Computador , Desfibriladores , Cardioversão Elétrica , Emergências , Serviços Médicos de Emergência/métodos , Socorristas , Educação em Saúde , Pessoal de Saúde/educação , Recursos em Saúde , Parada Cardíaca/tratamento farmacológico , Massagem Cardíaca/métodos , Massagem Cardíaca/normas , Humanos , Internacionalidade , Manequins , Equipe de Assistência ao Paciente , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Risco , Ensino/métodos , Ensino/normas , Materiais de Ensino/normasRESUMO
In summary, the evidence review process has attempted to provide a systematic review of the scientific literature using a priori defined methods. The details and steps of the literature review are transparent and replicable. External opinions and community critique are highly valued, and the final products represent the combined labor of hundreds of participants.
Assuntos
American Heart Association , Reanimação Cardiopulmonar/ética , Conflito de Interesses , Medicina Baseada em Evidências/ética , Guias de Prática Clínica como Assunto , Cardiologia/ética , Cardiologia/normas , Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/normas , Medicina Baseada em Evidências/normas , Humanos , Percepção , Guias de Prática Clínica como Assunto/normas , Estados UnidosAssuntos
Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/normas , Medicina Baseada em Evidências/métodos , Parada Cardíaca/terapia , Guias de Prática Clínica como Assunto , American Heart Association , Conflito de Interesses , Consenso , Previsões , Humanos , Armazenamento e Recuperação da Informação , Internet , Literatura de Revisão como Assunto , Estados UnidosAssuntos
Reanimação Cardiopulmonar/normas , Atenção à Saúde/normas , Serviços Médicos de Emergência/normas , Parada Cardíaca/terapia , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Reanimação Cardiopulmonar/métodos , Desfibriladores , Atenção à Saúde/ética , Atenção à Saúde/organização & administração , Intervenção Médica Precoce , Emergências , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Primeiros Socorros/normas , Parada Cardíaca/diagnóstico , Parada Cardíaca/epidemiologia , Parada Cardíaca/prevenção & controle , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Análise de Sistemas , TelemetriaRESUMO
The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.
Assuntos
American Heart Association , Cardiologia/normas , Reanimação Cardiopulmonar/normas , Guias de Prática Clínica como Assunto/normas , Cardiologia/métodos , Reanimação Cardiopulmonar/métodos , Doenças Cardiovasculares/terapia , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Humanos , Estados UnidosAssuntos
Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/normas , Parada Cardíaca/terapia , Guias de Prática Clínica como Assunto , Adulto , Biomarcadores/sangue , Reanimação Cardiopulmonar/métodos , Criança , Consenso , Cardioversão Elétrica/normas , Emergências , Serviços Médicos de Emergência/métodos , Medicina Baseada em Evidências , Primeiros Socorros , Parada Cardíaca/tratamento farmacológico , Humanos , Recém-Nascido , Monitorização Fisiológica/normas , Fibrilação Ventricular/terapiaRESUMO
It is not known how often lean tools and implementation determinants frameworks or checklists are used concurrently in health care quality improvement activities. The authors systematically reviewed the literature for studies that used a lean tool along with an implementation science determinants framework (January 1999 through August 2018). Seven studies (8 publications) were identified, inclusive of 2 protocols and 6 research articles across multiple continents. All included studies used the consolidated framework for implementation research as their implementation science determinants framework. Lean tools included in more than 1 publication were process mapping (4 publications), process redesign (3 publications), and 5S standardization (2 publications). Only 1 study proposed using a lean tool concurrently with an implementation science determinants framework in the design and execution of the QI project. Few published studies utilize both an implementation science determinants framework or checklist and 1 or more lean tool in their study design.
Assuntos
Ciência da Implementação , Melhoria de Qualidade/organização & administração , Gestão da Qualidade Total/organização & administração , HumanosRESUMO
BACKGROUND: Lean Thinking is a management philosophy derived from the manufacturing industry, where Toyota has long been the gold standard. Health care organizations have started to apply this approach to patient care. After initial experimentation, the University of Michigan Health System (UMHS) has adopted Lean Thinking as its uniform approach to quality improvement and is striving to become a complete Lean organization. PROJECTS: In 2005, the senior leadership selected an initial set of projects in areas that traced the patient's journey across different care settings within our health system. Four of the projects were as follows: orthopedic surgery clinic scheduling, radiation oncology therapy, peripherally inserted central catheter (PICC) services, and coordination of care to the outpatient setting. LESSONS FROM LEAN THINKING: Lean Thinking encourages service providers to focus on value as defined by the customer and the relentless elimination of waste that impedes the flow of value. A series of learning projects were conducted to test whether Lean methods would work at UMHS. The following factors were found to be key to LEAN PROJECT SUCCESS: expert guidance for initial efforts, leadership in the form of clinical champions and senior management support of the improvement work, frontline worker engagement in mapping out "current state" processes, identifying waste and designing an improved "future state," using metrics to develop and track interventions, and defining realistic project scope. FINAL REFLECTIONS: As UMHS's experience applying Lean Thinking to our patient care processes has grown, so have support, enthusiasm, and expertise within the organization. UMHS's Lean Thinking system, now known as the Michigan Quality System, has emerged as the core improvement strategy.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Difusão de Inovações , Eficiência Organizacional , Garantia da Qualidade dos Cuidados de Saúde/métodos , Michigan , Estudos de Casos Organizacionais , Objetivos Organizacionais , Garantia da Qualidade dos Cuidados de Saúde/organização & administraçãoRESUMO
Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines. © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.
Assuntos
Reanimação Cardiopulmonar/normas , Consenso , Desfibriladores/normas , Serviços Médicos de Emergência/normas , Parada Cardíaca Extra-Hospitalar/terapia , Fatores Etários , Reanimação Cardiopulmonar/educação , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Recuperação de Função Fisiológica , Tempo para o TratamentoAssuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência/normas , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Arritmias Cardíacas/terapia , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Cardioversão Elétrica , Parada Cardíaca/terapia , Humanos , Infarto do Miocárdio/terapia , Qualidade de Vida , Respiração ArtificialRESUMO
Outcome after cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002, a task force of the International Liaison Committee on Resuscitation (ILCOR) met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (ie, essential and desirable) data elements recommended by previous Utstein consensus conferences. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, emergency medical services system, and community.