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Updated: Mar 18, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Improving Providers' Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest Response.

Marion Leary1, William Schweickert2, Stacie Neefe2

  • 1Marion Leary is the Director of Innovation Research, Center for Resuscitation Science, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. William Schweickert is an assistant professor, Division of Allergy and Pulmonary Critical Care, Perelman School of Medicine at the University of Pennsylvania. Stacie Neefe is a nurse clinical coordinator, Department of Nursing, Hospital of the University of Pennsylvania. Boris Tsypenyuk is a project manager, Clinical Effectiveness and Quality Improvement Department, University of Pennsylvania. Scott Austin Falk is an assistant professor, Department of Anesthesia and Critical Care, Perelman School of Medicine at the University of Pennsylvania. Daniel N. Holena is an assistant professor, Division of Traumatology, Surgical Critical Care and Emergency Surgery and a senior scholar, The Leonard Davis Institute, Wharton School of Business, University of Pennsylvania. Marion.leary@uphs.upenn.edu.

American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses
|July 3, 2016
PubMed
Summary
This summary is machine-generated.

A bundled intervention reduced overcrowding during in-hospital cardiac arrest (IHCA) events. This approach improved role clarity for providers but did not significantly change perceptions of communication or leadership.

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Area of Science:

  • Emergency Medicine
  • Healthcare Quality Improvement
  • Team Dynamics in Critical Care

Background:

  • Nontechnical factors like role ambiguity and overcrowding can impact outcomes during in-hospital cardiac arrest (IHCA).
  • The effect of these factors on IHCA outcomes remains largely unknown.
  • A bundled intervention was developed to address role definition and overcrowding during IHCA events.

Purpose of the Study:

  • To evaluate a bundled intervention aimed at improving provider role definitions and reducing overcrowding during IHCA.
  • To assess the intervention's impact on perceptions of communication and team leadership.
  • The intervention included a nurse/physician leadership dyad, visual role cues, and a 'role check' process.

Main Methods:

  • Collected baseline data on provider numbers and types during IHCA events.
  • Administered post-event surveys to assess communication and leadership perceptions.
  • Implemented a bundled intervention and subsequently collected data on IHCA events.
  • Compared provider numbers and survey ratings before and after the intervention.

Main Results:

  • A significant decrease in the number of physicians at pulse checks and overall providers at the third pulse check was observed post-intervention.
  • Ratings for communication and physician leadership did not significantly change.
  • High percentages of physician leads (90%) and primary nurses (97%) could identify clear nurse leaders.

Conclusions:

  • The bundled intervention effectively reduced overcrowding during IHCA events.
  • The intervention improved the clarity of nurse leadership roles.
  • No substantial changes in perceived communication or physician leadership were noted.