Video Case Review for Quality Improvement During Cardiac Arrest
Resuscitation in the Emergency Department
Abstract
Background: Cardiac arrests (CA) are a leading global cause of
mortality. The American Heart Association (AHA) promotes several
important strategies associated with improved cardiac arrest outcomes,
including decreasing pulse check time and maintaining a chest
compression fraction (CCF) > 0.80. Video review is a
potential tool to improve skills and analyze deficiencies in various
situations, however its use in improving medical resuscitation remains
poorly studied in the emergency department (ED). We implemented a
quality improvement initiative, which utilized video review of cardiac
arrest resuscitations in an effort to improve compliance with such AHA
quality metrics. Methods: A cardiopulmonary resuscitation Video Review
Team (CoVeRT) of emergency medicine residents were assembled to analyze
CA resuscitations in our urban academic ED. Videos were reviewed by two
residents, one of whom was a senior resident (PGY-3 or -4), and analyzed
for numerous quality improvement metrics, including pulse check time,
CCF, time to intravenous access, and time to patient attached to
monitor. Results: We collected data on 94 cardiac arrest resuscitations
between July 2017 and June 2020. Average pulse check time was 13.09 (SD
±5.97) seconds, and 38% of pulse checks were less than 10 seconds.
After the implementation of the video review process, there was a
significant decrease in average pulse check time (p=0.01) and a
significant increase in CCF (p=0.01) throughout the study period.
Conclusions: Our study suggests that the video review and feedback
process was significantly associated with improvements in AHA quality
metrics for resuscitation in CA among patients presented to the ED.