How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study

Circulation. 2018 Jul 10;138(2):154-163. doi: 10.1161/CIRCULATIONAHA.118.033674.


Background: In-hospital cardiac arrest (IHCA) is common, and outcomes vary substantially across US hospitals, but reasons for these differences are largely unknown. We set out to better understand how top-performing hospitals organize their resuscitation teams to achieve high survival rates for IHCA.

Methods: We calculated risk-standardized IHCA survival to discharge rates across American Heart Association Get With The Guidelines-Resuscitation registry hospitals between 2012 and 2014. We identified geographically and academically diverse hospitals in the top, middle, and bottom quartiles of survival for IHCA and performed a qualitative study that included site visits with in-depth interviews of clinical and administrative staff at 9 hospitals. With the use of thematic analysis, data were analyzed to identify salient themes of perceived performance by informants.

Results: Across 9 hospitals, we interviewed 158 individuals from multiple disciplines including physicians (17.1%), nurses (45.6%), other clinical staff (17.1%), and administration (20.3%). We identified 4 broad themes related to resuscitation teams: (1) team design, (2) team composition and roles, (3) communication and leadership during IHCA, and (4) training and education. Resuscitation teams at top-performing hospitals demonstrated the following features: dedicated or designated resuscitation teams; participation of diverse disciplines as team members during IHCA; clear roles and responsibilities of team members; better communication and leadership during IHCA; and in-depth mock codes.

Conclusions: Resuscitation teams at hospitals with high IHCA survival differ from non-top-performing hospitals. Our findings suggest core elements of successful resuscitation teams that are associated with better outcomes and form the basis for future work to improve IHCA.

Keywords: cardiac arrest, sudden; cardiopulmonary resuscitation; health services research; qualitative research; quality improvement.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Cardiology Service, Hospital / organization & administration*
  • Cardiology Service, Hospital / standards
  • Cardiopulmonary Resuscitation* / adverse effects
  • Cardiopulmonary Resuscitation* / mortality
  • Cardiopulmonary Resuscitation* / standards
  • Clinical Competence* / standards
  • Cooperative Behavior
  • Death, Sudden, Cardiac / prevention & control*
  • Heart Arrest / diagnosis
  • Heart Arrest / mortality
  • Heart Arrest / physiopathology
  • Heart Arrest / therapy*
  • Humans
  • Inpatients*
  • Inservice Training
  • Interdisciplinary Communication
  • Interviews as Topic
  • Leadership
  • Patient Care Team / organization & administration*
  • Patient Care Team / standards
  • Qualitative Research
  • Quality Indicators, Health Care
  • Treatment Outcome
  • United States