Brian Eigel is singularly focused on improving cardiac arrest survival rates. In the US, he says, patients in a hospital only have a one in four chance of surviving an incident of cardiac arrest. While nurses, doctors, EMTs, and other healthcare professionals receive substantial training and are “ready to save lives every day,” Eigel, chief operating officer for healthcare organization RQI Partners LLC, a joint venture between the American Heart Association and Laerdal Medical, notes that there are still some commonly held beliefs about cardiac arrest and CPR training that prevent medical professionals from saving as many lives as possible.
With the Resuscitation Quality Improvement (RQI) Program, Eigel and RQI Partners are working with hospitals around the country to dispel these myths that will create opportunities to save more lives by improving cardiac arrest competency across the entire healthcare industry.
Myth 1: “Because I have a CPR card, I’m good at CPR.”
One of the most pernicious beliefs Eigel’s work seeks to dispel is the idea that having a CPR card and being skilled at CPR is the same thing. “We all have a driver’s license, but that only tells people you know how to drive, not how well you drive,” Eigel says. CPR cardholders only have to take the certification test every two years. “That’s not much practice,” Eigel says. “You can’t be proficient at things you only practice every two years.” In fact, studies show that CPR skills demonstrably decay after six months of not using them. It is the actual CPR performance on a patient that will significantly determine if the patient lives or dies, making it critically important that every healthcare provider is truly competent in providing high-quality CPR every time on every patient.
RQI provides healthcare professionals a low-dose/high-frequency quality improvement platform for quarterly CPR skill refreshers. Ten to fifteen minutes of hands-on CPR practice is provided, with the help of an advanced CPR mannequin equipped with sensors that offer quantitative feedback along five crucial components: rate and depth of compressions, recoil, hand position, and volume of air given.
Users then get real-time feedback on their strengths and weaknesses, and they immediately know whether or not they are doing a good job. This translates into making cardholders more confident and competent in working with patients, says Eigel. This paradigm shift results in the healthcare provider receiving an American Heart Association e-credential that verifies they are competent in CPR, rather than a traditional card that showed a CPR course was completed within the past two years. Eigel hopes this helps establish a new standard of care: being competent and verified in your competence.
Myth 2: “I know I provide high-quality CPR.”
Overconfidence is another problem frequently experienced by healthcare providers, who believe their CPR performance is better than it really is. This is not a value judgment on healthcare providers, though, Eigel adds: “It is very difficult to consistently perform high-quality CPR without routine feedback and practice to create the right muscle memory.” There is an increasing amount of evidence that healthcare providers, all of whom have a valid CPR card, fail to perform high-quality CPR on their cardiac arrest patients. Eigel notes that even the most motivated and trained medical professionals can suffer from these kinds of blind spots.
High-quality CPR is the single biggest determinant of survival and RQI has taken strides to address these gaps in understanding of CPR performance through seminars, publishing journal articles, and partnering with early adopters to pioneer this new lifesaving platform. Now in hundreds of hospitals across the US, RQI users report feeling more confident and competent in their CPR skills, leading to multiple reports of lives being saved inside and outside hospitals, Eigel says.
Myth 3: “CPR quality is not a problem at our hospital.”
Healthcare professionals might not just be unaware of their own CPR competencies, but might extend those overestimations to their entire organization. “For the past thirty to forty years, the basic paradigm has been that if everyone in a hospital has a CPR card, they follow the algorithm, they get the training, then there’s no problem,” Eigel says. “Whatever happens in terms of patient outcomes was acceptable as long as everyone followed their training and protocols.”
With RQI’s quality improvement sessions and e-credential verifying competence, Eigel says for the first time hospital staff will know the actual level of CPR skill across their institution. RQI’s platform collects every possible CPR measure and tracks performance of healthcare providers, using an analytics suite to show administrators and staff how they do organization-wide. This is useful from a quality assurance perspective as well, allowing administrators to know that “every person in their hospital is competent at CPR,” says Eigel. This cuts down on the kinds of institutional entrenchment that occasionally occur at hospitals and allows them to experience improved outcomes.
Myth 4: “Our survival rates are at the national average, so we’re doing well.”
Some hospitals may believe it is impossible to improve their cardiac arrest survival rates above the national average. Eigel, however, feels differently. One of RQI’s goals is to achieve greater consistency among all hospitals for cardiac arrest survival rates; currently, Eigel cites a 42 percent variation in survival outcomes depending on where someone goes into cardiac arrest.
With RQI’s e-credential programs, Eigel asserts that hospital staff will gain higher quality training and a better understanding of their competencies, resulting in better, more consistent performance and outcomes regardless of a hospital’s location.
Myth 5: “We don’t have the time or money to change our CPR strategy.”
While hospitals are constantly beset with budget constraints, the cost-effectiveness of the RQI platform can be incorporated into training without making a big impact on the bottom line, Eigel says. By having short ten to fifteen-minute quarterly quality improvement sessions, workers no longer have to leave patient care for a three-hour course, forcing hospitals to find ways to cover these shifts.
Eigel considers it a “win-win-win” for employees and employers alike: patients receive higher quality care, resulting in lives saved; employees more efficiently learn while becoming CPR competent; employers save time and money using the RQI platform compared to traditional classroom training. One customer was so impressed by the program and the quality improvement it afforded patients that RQI was added to the list of quality improvement processes in which faculty could participate and realize malpractice insurance premium reduction.
The overall result of RQI’s new competency standards, and the technology used to facilitate them, is the creation of a comprehensive platform to establish a new standard of care and competency that is affordable for hospitals to implement, and a new frontier in CPR training.