A 6-Year Thematic Review of Reported Incidents Associated With Cardiopulmonary Resuscitation Calls in a United Kingdom Hospital.

BACKGROUND: Critical incident reporting can be applied to cardiopulmonary resuscitation (CPR) events as a means of reducing further occurrences. We hypothesized that local CPR-related events might follow patterns only seen after a long period of analysis. DESIGN: We reviewed 6 years of local incidents associated with cardiac arrest calls. The following search terms were used to identify actual or potential resuscitation events: "resuscitation," "cardio-pulmonary," "CPR," "arrest," "heart attack," "DNR," "DNAR," "DNACPR," "Crash," "2222." All identified incidents were independently reviewed and categorized, looking for identifiable patterns. SETTING: Nottingham University Hospitals is a large UK tertiary referral teaching hospital. RESULTS: A total of 1017 reports were identified, relating to 1069 categorizable incidents. During the same time, there were approximately 1350 cardiac arrest calls, although it should be noted that many arrest-related incidents were not associated with cardiac arrest call (e.g., failure to have the correct equipment available in the event of a cardiac arrest). Incidents could be broadly classified into 10 thematic areas: no identifiable incident (n = 189; 18%), failure to rescue (n = 133; 12%), staffing concerns (n = 134; 13%), equipment/drug concerns (n = 133; 12%), communication issues (n = 122; 10%), do-not-attempt-CPR decisions (n = 101; 9%), appropriateness of patient location or transfer (n = 96; 9%), concerns that the arrest may have been iatrogenic (n = 76; 7%), patient or staff injury (n = 43; 4%), and miscellaneous (n = 52; 5%). Specific patterns of events were seen within each category. CONCLUSIONS: By reviewing incidents, we were able to identify patterns only noticeable over a long time frame, which may be amenable to intervention. Our findings may be generalizable to other centers or encourage others to undertake this exercise themselves.

Development of a critical care ultrasound curriculum using a mixed-methods needs assessment and engagement of frontline healthcare professionals.

PURPOSE: Experts recommend that critical care medicine (CCM) practitioners should be adept at critical care ultrasound (CCUS). Published surveys highlight that many institutions have no deliberate strategy, no formalized curriculum, and insufficient engagement of CCM faculty and trainees. Consequently, proficiency is non-uniform. Accordingly, we performed a needs assessment to develop an inter-professional standardized CCUS curriculum as a foundation towards universal basic fluency. METHODS: Mixed-methods study of CCM trainees, attendings, and nurse practitioners working across five academic and community medical-surgical intensive care units in Edmonton, Alberta. We used qualitative focus groups followed by quantitative surveys to explore, refine, and integrate results into a curriculum framework. RESULTS: Focus groups with 19 inter-professional practitioners identified major themes including perceived benefits, learning limitations, priorities, perceived risks, characteristics of effective instruction, ensuring long-term success, and achieving competency. Sub-themes highlighted rapid attrition of skill following one- to two-day workshops, lack of skilled faculty, lack of longitudinal training, and the need for site-based mentorship. Thirty-five practitioners (35/70: 50%) completed the survey. Prior training included workshops (16/35; 46%) and self-teaching (11/35; 31%). Eleven percent (4/35) described concerns about potential errors in CCUS performance. The survey helped to refine resources, content, delivery, and assessment. Integration of qualitative and quantitative findings produced a comprehensive curriculum framework. CONCLUSION: Building on published recommendations, our needs assessment identified additional priorities for a CCUS curriculum framework. Specifically, there is a perceived loss of skills following short workshops and insufficient strategies to sustain learning. Addressing these deficits could narrow the gap between national recommendations and frontline needs.

RéSUMé: OBJECTIF: Les experts recommandent que les intensivistes soient habiles en échographie aux soins intensifs. Les sondages publiés révèlent que de nombreux établissements ne possèdent pas de stratégie réfléchie ni de curriculum formalisé en échographie, tout en souffrant d'un manque d'implication du corps professoral et des résidents. Les aptitudes ne sont donc pas uniformes. C'est pourquoi nous avons réalisé une évaluation des besoins afin de mettre au point un curriculum interprofessionnel standardisé en échographie aux soins intensifs qui servira de fondation vers une maîtrise des aptitudes de bases universelles. MéTHODE: Nous avons réalisé une étude en méthodes mixtes auprès de résidents, de patrons et d'infirmiers et infirmières praticiens en soins intensifs travaillant dans cinq unités de soins intensifs médico-chirurgicaux universitaires et communautaires à Edmonton, en Alberta. Nous avons formé des groupes de réflexion qualitatifs puis avons réalisé des sondages quantitatifs afin d'explorer, d'approfondir et d'intégrer nos résultats dans un cadre de curriculum. RéSULTATS: Des groupes de réflexion composés de 19 praticiens interprofessionnels ont identifié des thèmes majeurs, notamment les avantages perçus, les obstacles à l'apprentissage, les priorités, les risques perçus, les caractéristiques d'un enseignement efficace, l'assurance d'un succès à long terme et l'acquisition des compétences. Les sous-thèmes ont mis en lumière une attrition rapide des compétences après des ateliers d'un ou deux jours, le manque d'enseignants compétents, le manque de formation longitudinale, et le besoin de mentorat sur le lieu de travail. Trente-cinq praticiens (35/70; 50 %) ont répondu au sondage. Les formations antérieures incluaient des ateliers (16/35; 46 %) et de l'auto-apprentissage (11/35; 31 %). Onze pourcent (4/35) des répondants ont fait part d'inquiétudes concernant les erreurs potentielles dans la performance de l'échographie aux soins intensifs. Le sondage a permis de raffiner les ressources, le contenu, la livraison et l'évaluation. L'intégration des résultats qualitatifs et quantitatifs a permis de réaliser un cadre exhaustif de curriculum. CONCLUSION: En nous appuyant sur les recommandations publiées, notre évaluation des besoins a identifié des priorités supplémentaires pour encadrer une formation d'échographie destinée aux soins intensifs. Plus spécifiquement, il existe une perte perçue des compétences à la suite d'ateliers courts et il manque de stratégies pour soutenir l'apprentissage. En palliant ces manques, il pourrait être possible de réduire le fossé entre les recommandations nationales et les besoins en première ligne.