Low-performing hospitals can improve quality for in-hospital cardiac arrest over time

A study found that while percentile rankings for risk-standardized survival rates remained generally consistent during follow-up periods at 45.2% of 166 study hospitals, 21.4% of bottom-performing hospitals exhibited substantial improvements on this quality metric.

Risk-standardized survival rates (RSSRs) for in-hospital cardiac arrest remained generally steady from 2012 to 2013 versus 2016 to 2017 but improved substantially in some low-performing hospitals, according to a recent study.

Researchers used data from hospitals that continuously participated in Get With The Guidelines–Resuscitation to determine RSSRs during a baseline period from 2012 to 2013 and two follow-up periods, 2014 to 2015 and 2016 to 2017. Hospitals were classified at baseline as top-, middle-, and bottom-performing if they ranked in the top 25%, the middle 50%, and the bottom 25%, respectively, for RSSR during 2012 to 2013. The study's primary outcome was each hospital's RSSR, representing rate of survival to discharge for patients with in-house cardiac arrest over a given time period. RSSRs are adjusted for each patient's illness severity to allow survival comparisons across sites. Results of the study were published Sept. 10 by Circulation: Cardiovascular Quality and Outcomes.

Data from 84,089 patients at 166 hospitals were included in the analysis. At baseline, the mean age of the study population was 64.8 years, 58.7% were men, and 24% were Black. Forty-two hospitals were categorized as top-performing, 82 were categorized as middle-performing, and 42 were categorized as bottom-performing. Median RSSRs were 31.7%, 24.6%, and 18.7%, respectively. More than 70% of top-performing hospitals ranked in the top 50% of RSSRs during both follow-up periods. During 2014 to 2015 and 2016 to 2017, respectively, 54.6% and 40.4% remained in the top 25% of RSSRs. Among bottom-performing hospitals, almost 75% remained in the bottom 50% of RSSRs during both follow-up periods. During 2014 to 2015 and 2016 to 2017, 50.0% and 40.5%, respectively, were in the bottom 25% of RSSRs. Percentile rankings remained generally consistent over time at 45.2% of the study hospitals. However, 21.4% of bottom-performing hospitals exhibited substantial improvements in percentile rankings over time and 23.7% of top-performing hospitals showed large declines in percentile rankings versus baseline.

Among other limitations, the study included only hospitals that had at least 20 cases of in-hospital cardiac arrest in any given year and continuous participation in the Get with the Guidelines–Resuscitation program, and the results could have been affected by residual confounding, the authors noted. They concluded that the RSSR metric for in-hospital cardiac arrest during a baseline period will generally be consistent for most hospitals during subsequent follow-up. “However, percentile rankings did change markedly at a small proportion of bottom-performing hospitals during the follow-up period, suggesting the opportunity to improve survival outcomes,” they wrote. “Future studies are needed to identify strategies and care innovations that were adopted by these bottom-performing hospitals.”