Changing the Culture to Improve CCF: An Improvement Project

Area of Science:

• Emergency Medicine
• Quality Improvement Science

Background:

• Chest Compression Fraction (CCF) is a critical process measure in cardiac arrest resuscitation, directly impacting patient survival rates.
• Improving CCF is a key objective for Emergency Medical Services (EMS) agencies aiming to enhance patient outcomes.
• Baseline CCF in paramedic-attended medical cardiac arrests was identified as an area requiring significant improvement.

Purpose of the Study:

• To improve the monthly median CCF from a baseline of 81.5% to 90% or higher in paramedic-attended medical cardiac arrests.
• To implement and evaluate targeted interventions focused on paramedics within a large urban 9-1-1 system.
• To achieve measurable improvements in resuscitation performance through systematic quality improvement initiatives.

Main Methods:

• Utilized repeated Plan-Do-Study-Act (PDSA) cycles, incorporating brainstorming, focus groups, and data review.
• Implemented interventions including standardized clinician feedback forms, enhanced follow-up for ongoing resuscitations, a dedicated CPR team leader, and pre-charged defibrillators.
• Evaluated intervention effectiveness through weekly/monthly CCF performance tabulation, participant feedback, and control chart analysis, adhering to SQUIRE 2.0 guidelines.

Main Results:

• Control chart analysis indicated special cause variation, leading to an increase in average CCF to 89.0%.
• Successful implementation of process changes via PDSA cycles drove the observed improvement in CCF.
• Clinician feedback forms were identified as the most effective and well-received intervention; other key contributors included patient-team reunification and pre-charging defibrillators.

Conclusions:

• Targeted education, consistent clinician feedback, patient-team reunification, and high-performance resuscitation strategies demonstrably improve CCF.
• The study highlights the effectiveness of systematic quality improvement approaches in enhancing critical care delivery.
• Achieving near-target CCF demonstrates the potential for significant gains in resuscitation quality within EMS systems.