Enhancing CPR During Transition From Prehospital to Emergency Department: A QI Initiative

Area of Science:

• Emergency Medicine
• Pediatric Critical Care
• Quality Improvement Science

Background:

• High-quality cardiopulmonary resuscitation (CPR) is crucial for pediatric out-of-hospital cardiac arrest (OHCA) survival.
• Maintaining CPR quality during prehospital to pediatric emergency department (PED) transitions is a significant challenge.
• Minimizing pauses in chest compressions during handoffs aligns with American Heart Association guidelines.

Purpose of the Study:

• To minimize CPR interruptions during prehospital to PED handoffs for pediatric OHCA patients.
• To decrease total interruptions in compressions during the first 2 minutes of PED care from a baseline of 17 seconds to 10 seconds.
• To reduce the longest pause in compressions to under 10 seconds and time to defibrillator pad placement to under 120 seconds.

Main Methods:

• A multidisciplinary team designed and implemented interventions focused on specific roles, CPR handoff choreography, and provider empowerment.
• Data were collected by abstracting information from video recordings of pediatric OHCA patients receiving manual CPR upon arrival.
• The study analyzed 33 patient encounters between March 2018 and July 2019.

Main Results:

• Total interruptions in compressions during the first 2 minutes decreased from 17 to 12 seconds.
• The longest single pause in compressions decreased from 14 to 7 seconds.
• Variability in the time to defibrillator pad placement was reduced.

Conclusions:

• A quality improvement initiative utilizing CPR transition choreography effectively reduced interruptions in chest compressions.
• The intervention also decreased variability in the time to defibrillator pad placement.
• These improvements enhance the continuity and quality of care during critical transitions for pediatric OHCA patients.