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. 2021 Apr 21;6(1):14.
doi: 10.1186/s41077-021-00168-y.

The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation quality improvement program in early UK adopter hospitals

Katherine Kuyt  1 , Montana Mullen  1 , Catherine Fullwood  2   3 , Todd P Chang  4 , James Fenwick  5 , Victoria Withey  6 , Rod McIntosh  7 , Naomi Herz  8 , Ralph James MacKinnon  9
Affiliations

The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation quality improvement program in early UK adopter hospitals

Katherine Kuyt et al. Adv Simul (Lond). .

Abstract

Background: Adult and paediatric basic life support (BLS) training are often conducted via group training with an accredited instructor every 24 months. Multiple studies have demonstrated a decline in the quality of cardio-pulmonary resuscitation (CPR) performed as soon as 3-month post-training. The 'Resuscitation Quality Improvement' (RQI) programme is a quarterly low-dose, high-frequency training, based around the use of manikins connected to a cart providing real-time and summative feedback. We aimed to evaluate the effects of the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted this as a method of BLS training, and establish whether this program leads to increased compliance in CPR training.

Methods: The study took place across three adopter sites and one control site. Participants completed a baseline assessment without live feedback. Following this, participants at the adopter sites followed the RQI curriculum for adult CPR, or adult and infant CPR. The curriculum was split into quarterly training blocks, and live feedback was given on technique during the training session via the RQI cart. After following the curriculum for 12/24 months, participants completed a second assessment without live feedback.

Results: At the adopter sites, there was a significant improvement in the overall score between baseline and assessment for infant ventilations (N = 167, p < 0.001), adult ventilations (n = 129, p < 0.001), infant compressions (n = 163, p < 0.001) adult compressions (n = 205, p < 0.001), and adult CPR (n = 249, p < 0.001). There was no significant improvement in the overall score for infant CPR (n = 206, p = 0.08). Data from the control site demonstrated a statistically significant improvement in mean score for adult CPR (n = 22, p = 0.02), but not for adult compressions (N = 18, p = 0.39) or ventilations (n = 17, p = 0.08). No statistically significant difference in improvement of mean scores was found between the grouped adopter sites and the control site. The effect of the duration of the RQI curriculum on CPR performance appeared to be minimal in this data set. Compliance with the RQI curriculum varied by site, one site maintained hospital compliance at 90% over a 1 year period, however compliance reduced over time at all sites.

Conclusions: This data demonstrated an increased adherence with guidelines for high-quality CPR post-training with the RQI cart, for all adult and most infant measures, but not infant CPR. However, the relationship between a formalised quarterly RQI curriculum and improvements in resuscitation skills is not clear. It is also unclear whether the RQI approach is superior to the current classroom-based BLS training for CPR skill acquisition in the UK. Further research is required to establish how to optimally implement the RQI system in the UK and how to optimally improve hospital wide compliance with CPR training to improve the outcomes of in-hospital cardiac arrests.

Keywords: Cardiopulmonary resuscitation; Simulation; Training.

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Conflict of interest statement

This work was in part funded Laerdal Medical. These funds covered the salary of study staff for time spent working on the study. NH is substantively employed by the British Heart Foundation.

Figures

Fig. 1
Fig. 1
The RQI cart. Including adult and infant manikins, bag-valve mask, and integrated laptop computer. Included with permission from Laerdal Medical
Fig. 2
Fig. 2
Example curriculum for a participant training in adult and infant BLS. Individuals who participated in training in adult BLS only, followed a similar structure of curriculum, but Q3, Q6, and Q8 focused on adult ventilation and adult compressions. Un-coached assessments were performed prior to commencing RQI training, and after following the curriculum for the set period of time. *Sites B and C only. + Data available for site A only
Fig. 3
Fig. 3
Example results and analytics from an adult rescue CPR course. Showing the overall score and the scores for different aspects that contribute. Included with permission from Laerdal Medical
Fig. 4
Fig. 4
Mean baseline and assessment scores for adopter sites. Mean scores, data grouped across all three adopter sides. *p < 0.001
Fig. 5
Fig. 5
Mean improvement in overall score from baseline to assessment scores according to the length of the curriculum followed. Data spilt into control site (no curriculum), sites assessed after following the curriculum for 4 quarters, and the site assessed after following the curriculum for 8 quarters. The control site did not partake in infant assessments
Fig. 6
Fig. 6
Overall compliance during the RQI curriculum, by site. Each participant could be assigned more than one course per quarter; for example, adult ventilations and adult compressions. Assessment performed after Q4 for sites B and C
Fig. 7
Fig. 7
Percentage compliance according to due date across all sites. The percentage of assigned courses completed by due date, completed less than one quarter past due, and completed more than one-quarter past due. Data grouped across all sites according to the due date, regardless of curriculum stage assigned
See this image and copyright information in PMC

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