• Raina M Merchant, Lin Yang, Lance B Becker, Robert A Berg, Vinay Nadkarni, Graham Nichol, Brendan G Carr, Nandita Mitra, Steven M Bradley, Benjamin S Abella, Peter W Groeneveld, and American Heart Association Get With the Guideline-Resuscitation Investigators.
• Department of Emergency Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA. raina.merchant@uphs.upenn.edu
• Med Care. 2012 Feb 1;50(2):124-30.

BackgroundIt is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability.ObjectivesMeasure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates.Research DesignGet with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals.ParticipantsAdult patients with IHCA.MeasuresCase-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score.ResultsWe evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; P<0.0001).ConclusionsCase-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.

17 keywords...

hide…