Background Improving sustained ROSC rates following out-of-hospital cardiac arrest is a key focus for ambulance services. Accordingly, a Quality Improvement (QI) project was initiated whereby an Intensive Care Society post-resuscitation care bundle of evidence-based interventions was adapted for use by pre-hospital clinicians. The objective was to introduce and embed this care bundle, in order to increase its delivery⇓.
Method A baseline audit of care bundle compliance was conducted in April–May 2012 to act as a pilot bundle and provide a baseline. The final care bundle, comprising five key elements, was introduced during a QI event attended by 60 clinicians in April 2013. Since then, care bundle delivery has been regularly monitored. To sustain early gains, a Post-ROSC checklist was distributed to frontline vehicles, and a QI Collaborative discussed individual elements. A defibrillator ‘aide memoire’ sticker was developed, and will be trialled using a PDSA cycle.
Results Care bundle delivery has progressed between the pilot period, and in the two subsequent years, demonstrating the success of the QI programme in embedding these interventions. Ventilatory support has received a particular focus, and the impact on provision is marked.
In future, the care bundle will be updated to reflect the latest research evidence, including new guidance on cooling. SPC charts will monitor the impact of QI activities.
Conclusion The care bundle model, alongside targeted QI activities, has proved successful in ensuring best-practice care is more routinely provided. These methods promote clinician co-production of practice development, and are adaptive to evolving clinical evidence.
- emergency department
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