Can J Emerg Med
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Comparative Study Observational Study
Accuracy of instructor assessment of chest compression quality during simulated resuscitation.
The 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario. ⋯ Instructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.
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Reducing pauses during cardiopulmonary resuscitation (CPR) compressions result in better outcomes in cardiac arrest. Artefact filtering technology (AFT) gives rescuers the opportunity to visualize the underlying electrocardiogram (ECG) rhythm during chest compressions, and reduces the pauses that occur before and after delivering a shock. We conducted a simulation study to measure the reduction of peri-shock pause and impact on chest compression fraction (CCF) through AFT. ⋯ In this cardiac arrest model, AFT results in a greater CCF by reducing peri-shock pause duration. There is also a small but detectable improvement in CCF with the addition of hands-on defibrillation.
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Computerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS). ⋯ CPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.