Akhtar, Naheed (2013) Evaluating processes to improve outcomes following in-hospital cardiac arrests. PhD thesis, University of Warwick.

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Abstract

Despite advancements in cardiopulmonary resuscitation (CPR), survival rates from in-hospital cardiac arrest (IHCA) remain relatively poor. The chain of survival depicts a stepwise process of care intended to improve outcomes from cardiac arrest. It comprises of four links – early recognition of cardiac arrest and activation of the emergency team, early CPR, early defibrillation and effective post resuscitation care. This thesis comprises of four research studies of investigations relating to evaluating processes to improve outcomes following IHCA linked to the chain of survival.
The first link in the chain of survival is the accurate identification of cardiac arrest and early mobilisation of the emergency team. The timeliness of the emergency response is critical to patient outcomes. Patient survival from cardiac arrest is nearly doubled when defibrillation occurs within three minutes; confirming the time critical nature of the emergency response. Study I and II examined the impact of quality of in-hospital emergency telephone calls duration on patient outcomes from IHCA. We have shown wide disparity in the duration of in-hospital clinical adult emergency telephone calls; there is an association between emergency response times and patient survival. The optimal process behind emergency call processes remains to be elucidated.
The second link in the chain of survival reflects the importance of performing high quality CPR. The quality of CPR delivery is a pivotal determinant of successful resuscitation. Observational studies have shown that the quality of CPR skill performance is suboptimal amongst healthcare professionals. Study III demonstrated that a video-based CPR program for developing healthcare professionals basic life support (BLS) skills proved to be an effective and feasible alternative for BLS training than traditional instructor training method. The implications of this research would be to focus on validating new training interventions on a case by case basis to ensure effective learning outcomes.
Human factors such as teamwork and leadership affect adherence to resuscitation guidelines and quality of CPR performance. Study IV identified four principal themes: ‘Influences of organisation on team dynamics’; ‘Understandings of leadership’; ‘Patterns of interaction which affect quality of teamwork’ and ‘Working towards a common goal’ which are important determinants of teamwork and leadership during actual resuscitation attempts. There is scope to improve the elements of non-technical skills that complement CPR skills pertinent to clinical practice.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	Cardiac arrest -- Treatment -- Evaluation, Cardiac resuscitation, CPR (First aid)
Official Date:	September 2013
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Perkins, Gavin D.; Cooke, Matthew, MB ChB; Lindenmeyer, Antje
Sponsors:	Resuscitation Council (UK)
Extent:	xviii, 274 leaves : illustrations, charts.
Language:	eng

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