In-hospital cardiac arrest rhythm analysis by anesthesiologists: a diagnostic performance study.

PURPOSE: In-hospital cardiac arrest is associated with high morbidity and mortality, with an overall survival rate at one year of approximately 13%. The first cardiac rhythm is often analyzed by anesthesiologist-intensivists. We aimed to determine the diagnostic performance of anesthesiologist-intensivists when distinguishing between shockable and nonshockable rhythms. METHODS: We conducted a simulation-based, multicentre, prospective, observational study between May 2019 and March 2020. The responses of the participants were used to calculate individual sensitivity (defined as the proportion of decisions to shock for shockable rhythms) and individual specificity (defined as the proportion of decisions not to shock for nonshockable rhythms). The main outcome measure was the overall diagnostic performance, defined as the overall sensitivity and specificity. Secondary outcome measures were the sensitivity and specificity of participants' decisions for each type of cardiac arrest rhythm and their decision-making times. RESULTS: Among the 267 physicians contacted, 179 (67%) completed the test. The median [interquartile range (IQR)] overall sensitivity was 88 [79-95]% and the median overall specificity was 86 [77-92]%. Among shockable rhythms, the median [IQR] sensitivity was 100 [100-100]% for ventricular tachycardia (VT), 100 [100-100]% for coarse ventricular fibrillation (VF), and 60 [20-100]% for fine VF. The median [IQR] specificities for nonshockable rhythms were 93 [86-100]% for asystole and 83 [72-86]% for pulseless electrical activity. The median decision times ranged from 2.0 to 3.5 sec. CONCLUSION: Anesthesiologist-intensivists were quickly and effectively able to analyze rhythms in this simulation-based study. Participants' sensitivity in deciding to deliver shocks for VT and coarse VF was excellent, while specificity of their decisions for pulseless electrical activity was insufficient.

RéSUMé: OBJECTIF: L'arrêt cardiaque intra-hospitalier est associé à une morbidité et mortalité élevées, associées à un taux de survie global à un an d'environ 13 %. Le premier rythme cardiaque est souvent analysé par des anesthésiologistes-intensivistes. Nous avons cherché à déterminer la performance diagnostique des anesthésiologistes-intensivistes à distinguer un rythme choquable d'un rythme non choquable. MéTHODE: Nous avons effectué une étude observationnelle prospective, multicentrique basée sur la simulation entre mai 2019 et mars 2020. Les réponses des participants ont été utilisées pour calculer la sensibilité individuelle (définie comme étant la proportion de décisions de choquer pour les rythmes choquables) et la spécificité individuelle (définie comme la proportion de décisions de ne pas choquer pour les rythmes non choquables). Le critère d'évaluation principal était la performance diagnostique globale, définie comme étant la sensibilité et la spécificité globales. Les critères d'évaluation secondaires étaient la sensibilité et la spécificité des décisions des participants pour chaque type de rythme d'arrêt cardiaque, ainsi que le temps de prise de décision. RéSULTATS: Parmi les 267 médecins contactés, 179 (67 %) ont complété le test. La sensibilité globale médiane [écart interquartile (ÉIQ)] était de 88 [79-95] % et la spécificité globale médiane était de 86 [77-92] %. Parmi les rythmes choquables, la sensibilité médiane [ÉIQ] était de 100 [100-100] % pour la tachycardie ventriculaire (TV), de 100 [100-100] % pour la fibrillation ventriculaire (FV) large et de 60 [20-100] % pour la FV fine. Les spécificités médianes [ÉIQ] pour les rythmes non choquables étaient de 93 [86-100] % pour l'asystolie et de 83 [72-86] % pour l'activité électrique sans pouls. Les temps de décision médians variaient de 2,0 à 3,5 secondes. CONCLUSION: Les anesthésiologistes-intensivistes ont été rapidement et efficacement en mesure d'analyser les rythmes dans cette étude basée sur la simulation. La sensibilité de prendre la décision d'administrer un choc pour une TV ou une FV était excellente pour les participants, tandis que la spécificité de cette décision pour l'activité électrique sans pouls était insuffisante.

Use of a risk assessment method to improve the safety of negative pressure wound therapy.

To conduct a risk analysis of the negative pressure wound therapy (NPWT) care process and to improve the safety of NPWT, a working group of nurses, hospital pharmacists, physicians and hospital managers performed a risk analysis for the process of NPWT care. The failure modes, effects and criticality analysis (FMECA) method was used for this analysis. Failure modes and their consequences were defined and classified as a function of their criticality to identify priority actions for improvement. By contrast to classical FMECA, the criticality index (CI) of each consequence was calculated by multiplying occurrence, severity and detection scores. We identified 13 failure modes, leading to 20 different consequences. The CI of consequences was initially 712, falling to 357 after corrective measures were implemented. The major improvements proposed included the establishment of 6-monthly training cycles for nurses, physicians and surgeons and the introduction of computerised prescription for NPWT. The FMECA method also made it possible to prioritise actions as a function of the criticality ranking of consequences and was easily understood and used by the working group. This study is, to our knowledge, the first to use the FMECA method to improve the safety of NPWT.

Hospital-based health technology assessment for innovative medical devices in university hospitals and the role of hospital pharmacists: learning from international experience.

OBJECTIVES: Several models of hospital-based health technology assessment (HTA) have been developed worldwide, for the introduction of innovative medical devices and support evidence-based decision making in hospitals. Two such models, the HTA unit and mini-HTA models, are widespread in university hospitals and involve various stakeholders. The purpose of this work was to highlight the potential role of hospital pharmacists in hospital-based HTA activities. METHODS: We searched for articles, reviews, and letters relating to hospital-based HTA, as defined by the Hospital-Based Health Technology Assessment Worldwide Survey published by the Health Technology Assessment International (HTAi) Society, in the Health Technology Assessment database, MEDLINE, EMBASE, and hospital pharmacy journals. RESULTS: The number of university hospitals performing hospital-based HTA has increased since the 2008 Hospital-Based Health Technology Assessment Worldwide Survey. Our own experience and international findings show that hospital pharmacists already contribute to hospital-based HTA activities and have developed study interpretation skills and a knowledge of medical devices. CONCLUSIONS: Promoting multidisciplinary approaches is one of the key success factors in hospital-based HTA. Hospital pharmacists occupy a position between hospital managers, clinicians, health economists, biomedical engineers, and patients and can provide a new perspective. In the future, hospital pharmacists are likely to become increasingly involved in hospital-based HTA activities.