Paris Hotel and Casino Las Vegas, Nevada Resuscitation Officer Program Code Committee organization Presented by: Scott Johnson, MD FACEP
Presenter Disclosure Information • Scott Johnson, MD FACEP • Resuscitation Officer Program -Code Committee organization • No relevant financial relationship (s) exist
Resuscitation Officer Program Code Committee organization Role of the Resuscitation Officer Qualities of a Chair Representation from Key Areas Dashboards
About Stony Brook • Academic tertiary care hospital, SOM affiliated • Beds: 603 • Inpatients 31,964 • ED visits: 96,021 • Employees: 5,777 • Physicians: 1,095 • Residents: 500 • Regional Trauma, Stroke and Cardiac Center • Clinical affiliate- PBMC
Stony Brook University Hospital • • 2013 (cardiac arrest data) 2014 (cardiac arrest data) (to date) • • 98 admitted from ED – 39 arrested 36 admitted from ED – 26 arrested in in the ED / 59 OHCA the ED / 10 OHCA • • 158 IHCA 73 IHCA • • 16 cath lab 3 cath lab / 1 non invasive • 32% survival to hospital discharge for IHCA • 12.8 % survival to hospital discharge for OHCA
Resuscitation Officer • RO is Hospital’s Champion for ensuring Cardiopulmonary Resuscitation quality! • Must have the passion, energy, expertise and skill set to organize and implement hospital and community- wide resuscitation programs • RO will have expertise in all aspects of Resuscitation • Clinical expertise • Management/Leadership skills • Teaching/Training skills • CQI expertise • Duties: • Organizing code committees (oversight) and code teams (clinical team) • Develop and maintain infrastructure, integrating key elements including innovative/EBM approaches/equipment • Ensure comprehensive and regular provider training • Develop and maintain robust CQI program * Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008
Resuscitation officer in UK
Summary Statement- RC UK • Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. • Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. • Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. • Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “ Cardiopul- monary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
Resuscitation Officer Standards- RC UK • Every organisation must have at least one person, the Resuscitation Officer (RO), resuscitation lead or resuscitation services manager, who is responsible for co-ordinating the teaching and training of staff in resuscitation. • This person will have additional important responsibilities (e.g. quality improvement, incident review). • One whole-time-equivalent RO is recommended for every 750 members of clinical staff . – Size of organization dictates number of ROs needed Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
Resuscitation Officer Standards- RC UK • Most ROs spend at least 50% of their time involved in training activities when all the different types of training and preparation are taken into account. • The remainder of an RO’s time includes other responsibilities such as audit, governance, DNACPR, clinical commitments, attending cardiac arrest calls, planning, finance, equipment checks, etc. • In order to maintain standards and clinical credibility, it is recommended that responding to and participating in cardiac arrest management is an integral part of the RO’s clinical responsibility on a week -to-week basis Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
Why Resuscitation officer in US? • There is “….considerable variability in cardiac arrest and resuscitation structures and processes, suggesting potential areas to target for improvement.” – Hospital cardiac arrest resuscitation practice in the United States: A nationally representative survey; J Hosp Med. 2014 Feb 19. Edelson DP, Yuen TC, Mancini ME, Davis DP, Hunt EA, Miller JA, Abella BS. • RO is Hospital’s Champion for ensuring Cardiopulmonary Resuscitation quality • RO has Expertise in Resuscitation • Clinical expertise • Management/Leadership skills • Teaching/Training skills • CQI expertise
Meaney PA, Bobrow BJ, Mancini ME, et al. Cardiopulmonary resusci- tation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128(4):417 – 435.
Meaney PA, Bobrow BJ, Mancini ME, et al. Cardiopulmonary resusci- tation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128(4):417 – 435.
Resuscitation Committee- RC UK • Healthcare institutions should have, or be represented on, a resuscitation committee that meets regularly, e.g., quarterly, and whose purpose is to ensure clear leadership of the resuscitation service. • The resuscitation committee should be responsible for implementing operational policies governing cardiopulmonary resuscitation, practice and training. It should determine the level of resuscitation training required by individual staff members. Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “ Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
Resuscitation Committee- RC UK • The resuscitation committee should be responsible for: – ensuring adherence to national resuscitation guidelines and standards; – defining the role and composition of the resuscitation team; – ensuring resuscitation equipment for clinical use is available; – ensuring appropriate resuscitation drugs (including those for peri-arrest situations) are available; – planning adequate provision of training in resuscitation ; – determining requirements for and choice of resuscitation – training equipment; – quality improvement – action plans based on audits, e.g. review of audit data using National Cardiac Arrest Audit data for benchmarking; – all policies relating to resuscitation and anaphylaxis; Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
Resuscitation Committee Standards- RC UK • Healthcare organisations admitting acutely ill patients must have a Resuscitation Committee with clearly defined terms of reference. • The organisation must have an executive board member responsible for resuscitation services. The Resuscitation Committee must be part of the organisation’s management structure (e.g. clinical governance, clinical risk, quality improvement, education committees). Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008).
Qualities of a Chair • The chair of the resuscitation committee should be a senior clinician with an active and credible involvement in resuscitation. This individual would be expected to have the authority to drive and implement change. * • In UK, leadership usually by nurses and pharmacists • Skill set ? * Joint statement by the Resuscitation Council (UK), Royal College of Anaesthetists, Royal College of Physicians (London) and the Intensive Care Society, “Cardiopulmonary resuscitation, standards for clinical practice and training”, 2004 (updated 2008
* Hospital cardiac arrest resuscitation practice in the United States: A nationally representative survey; J Hosp Med. 2014 Feb 19. Edelson DP, Yuen TC, Mancini ME, Davis DP, Hunt EA , Miller JA, Abella BS.
Resuscitation Committee Representation Critical Care/Intensivist Hospital Medicine Anesthesia Emergency Medicine Cardiology, Cardiothoracic Interventional surgery Pediatric Critical Care Obstetrics Neurology Hospital CQI team member Rapid Response Nursing team leadership Pharmacy/Biomedical Respiratory EMS engineering therapist
Structure of Committees Steering Committee Chairs of Committees Cardiac Rapid Prehospital Training Arrest Response
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