Abstract
BackgroundDespite advances in the management of sudden cardiac arrest, mortality for patients admitted to hospital is still greater than 50 %. Lack of familiarity and experience with post-cardiac arrest patients and lack of interdisciplinary collaboration between emergency and ICU staff have been highlighted as potential barriers to optimal care. To address these barriers, a specialized Post Arrest Consult Team (PACT) was implemented at two urban academic centers.Our objective was to describe the PACT implementation from the participant perspective in order to explore potentially mitigating factors on effectiveness of the intervention and inform other institutions who may be considering a similar approach.MethodsUsing an ethnographic style approach, we collected data throughout the implementation period using both key informant interviews and non-participant observation. The data were analyzed using interpretive descriptive analysis techniques.ResultsThe PACT intervention was taken up differently in each of the two participating institutions. Participants spoke about the difficulty in maintaining a dynamic interaction between the team members and a shared sense of purpose, the challenge of off-service consulting and the impact of the lack of data feedback to support whether the project was effecting change.ConclusionsIt appears that purposefully creating a “sense of team,” the team composition and organizational culture and provision of performance feedback are important facilitators to ensuring uptake of a team-based intervention like the PACT model. Reporting of the intervention design and actual implementation experience like we have done here is crucial to allow readers to judge the quality of the study, to properly replicate it, and to contemplate how various factors may influence the outcome of a complex intervention.
Highlights
Despite advances in the management of sudden cardiac arrest, mortality for patients admitted to hospital is still greater than 50 %
The qualitative data collected over the course of the implementation highlighted three major themes which represent key factors from the participant perspective that are highly informative for future implementations of Post Arrest Consult Team (PACT) type interventions
The importance of creating a “sense of team” While PACT RNs and MDs were generally trained together in terms of the clinical knowledge required to function in the role and required data collection, no explicit team building was done as part of the implementation plan
Summary
Despite advances in the management of sudden cardiac arrest, mortality for patients admitted to hospital is still greater than 50 %. Lack of familiarity and experience with post-cardiac arrest patients and lack of interdisciplinary collaboration between emergency and ICU staff have been highlighted as potential barriers to optimal care. To address these barriers, a specialized Post Arrest Consult Team (PACT) was implemented at two urban academic centers. A lack of interdisciplinary collaboration between emergency department (ED) and intensive care unit (ICU) staff and lack of access to advanced technology and specialized human resources are commonly identified as organizational barriers
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