Resuscitation Quality Improvement

Laerdal Medical Resuscitation Quality Improvement (RQI) Program

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Common challenges for resuscitation training today

Quality

Many healthcare providers do not perform CPR as a regular part of their clinical practice, and some rarely perform CPR outside of a annual or bi-annual training course (1). Research shows that CPR compression and ventilation skills deteriorate from lack of use and so does overall quality of CPR. This can happen in as little as 3 months after training (2).

Compliance

How can healthcare institutions ensure quality CPR and demonstrate adherence to protocols? Currently, busy healthcare professionals spend countless hours collating, confirming and documenting attendance required for external and internal reporting.

Cost

Traditional CPR training not only has a direct cost, in terms of fees for instructors or attendance, but there are also indirect costs, such as the loss of time on the ward or at the bedside which can result in reduced patient care.

The RQI program is designed to address these challenges

Low-dose high-frequency training to enable maintenance of competence

RQI allows healthcare providers to train in short, frequent intervals – known as low-dose high-frequency training. Skills Stations are deployed within the institution at convenient locations, for example close to workstations. The stations are used for quarterly skills assessments that can be completed on an average of 10 minutes, 24/7. Trainers receive real-time verbal and visual feedback when performing compressions and ventilations, measuring the quality of CPR delivered and designating a score.

A study in Pediatrics showed that frequent short training sessions, known as low-dose high-frequency training, more than doubled retention of high-quality CPR skills (3).

Laerdal Analytics - to support compliance and quality improvement

RQI comes with powerful data management tools such as dedicated learning management and analytical tools. In addition to real-time performance feedback for the learner, this provides a visual analysis of organisational. departmental and individual performance data that can be tracked over time. These reports will also identify targets for quality improvement measures, which are highly valuable in terms of auditing and management reporting.

In-Situ Training - to reduce cost and increase time for patient care

With RQI, the training is self-directed and comes to the learner. This keeps healthcare providers at their workplace and allows training to take place where it’s most convenient and suited to their schedule. Data from already implemented RQI programs, show that training now occurs 24/7 with training peaks around shift changes.

This also frees up time and money for instructors and faculty educators, allowing them to focus resources on team training and risk areas instead of basic skills.

Imagine if you had 1000 staff members trained per year for three and a half hours each in basic life support. By implementing the RQI program, you could reduce the training by at least one hour per person, minimum. That is a reduction of one thousand hours – per year.

One thousand hours more for patient care.

RQI in Action

Texas Health Resources, USA

Two years after the implementation of the RQI program at the Texas Health Resources hospital in Dallas, Texas, the hospital has achieved:

98% quarterly course completion
$250 000 reduction in CPR training costs
21% increase in survival rates

The Texas Health Resources staff now embrace the RQI program and express little desire to go back to the classroom based training, as the program meets their needs for quality improvement of CPR.

Cabrini Health, Australia

In order to meet National Safety and Quality Health Service (NSQHS) Standards, Cabrini Health of Australia rolled out RQI across their entire healthcare provider workforce.

100% of staff completed training and the data showed training could occur 24/7 with training peaks around shift changes.

With the help of RQI, they received a “Met with Merit” indication in their hospital accreditation.

"When we started the RQI program only 25% of our staff were able to perform chest compressions and ventilations at the required rate. Now we have more than 90% of staff exceeding the standard."

Matt Johnson, Cabrini Health, Australia

Referenced research:

Paramedic exposure to out-of-hospital cardiac arrest is rare and declining in Victoria Australia. Dyson et al. 2015. Resuscitation 89, 93-98.
Part 16: Education, Implementation, and Teams 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Bhanji et al. Circulation. 2010;122(suppl 3):S920-S933
Low-Dose, High-Frequency CPR Training Improves Skill Retention of In-Hospital Pediatric Providers. Sutton et al. Pediatrics. 2011;128:e145-e151