Abstract 15103: How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Differ? A Qualitative Study

Introduction: In-hospital cardiac arrest (IHCA) outcomes vary significantly across hospitals, but the reasons for these differences are largely unknown. This study used qualitative methods to explore potential organizational and contextual factors related to resuscitation teams that may contribute to better outcomes at top-performing hospitals. Methods: Using risk-standardized IHCA survival to discharge rates, we identified 6 geographically- and academically-diverse hospitals in the AHA Get-With-The-Guidelines Resuscitation registry during 2012 and 2013 (4 hospitals in the top quartile of IHCA survival, 1 in the middle quartiles, and 1 in the bottom quartile). We conducted 1-to-2 day site visits with in-depth interviews of clinical and administrative staff. Using a directed content analysis approach, data were analyzed and compared by a multidisciplinary team with salient themes identified. Results: A total of 97 interviews were conducted at the 6 hospitals. Participants included physicians (22.2%), nurses (56.4%), respiratory therapists (7.7%), quality improvement staff, administration and other (e.g., pharmacy, security, chaplain) (13.7%). Resuscitation teams at hospitals differed in regards to 4 domains: 1) Team Design (dedicated, designated or neither); 2) Composition (size and types of team members); 3) Roles and Responsibilities (delineation of roles prior to arrival at IHCA); and 4) Communication and Leadership during IHCA. Differences in these domains and representative quotations are shown (Table). Conclusions: Resuscitation teams at top-performing hospitals for IHCA fundamentally differ from lower-performing hospitals in their overall organization, composition, and function. These findings inform the development of new hypotheses to understand what works inside top-performing hospitals.