Improving Providers' Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest Response

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How nontechnical factors such as inadequate role definition and overcrowding affect outcomes of in-hospital cardiac arrest (IHCA) is unknown. Using a bundled intervention, we sought to improve providers' role definitions and decrease overcrowding during IHCA events.


To determine if a bundled intervention consisting of a nurse/physician leadership dyad, visual cues for provider roles, and a “role check” would lead to reductions in crowding and improve perceptions of communication and team leadership.


Baseline data on the number and type of IHCA providers were collected. Providers were asked to complete a postevent survey rating communication and leadership. A bundled intervention was then introduced. Data were then obtained for the subsequent IHCA events.


Twenty ICHA events were captured before and 34 after the intervention. The number of physicians present at pulse checks 2 (median [interquartile range]: 6 [5-8] before vs 5 [3-6] after, P = .02) and 3 (7 [5-9] vs 4 [4-5], P = .004) decreased significantly after the intervention. The overall number of providers at the third pulse check (18 [14-22] before vs 14 [12-16] after, P = .04) also decreased after the intervention. On a 10-point Likert scale, ratings of communication (8 [7-8]) and physician leadership (8 [7-9]) did not differ significantly from before to after the intervention. Both the physician leads (90%) and patients' primary nurses (97%) were able to identify clear nurse leaders.


A bundled intervention targeted at improving IHCA response led to a decrease in overcrowding at ICHA events without substantial changes in the perceptions of communication or physician leadership.

Approximately 200 000 in-hospital cardiac arrests (IHCAs) occur annually in the United States,1 resulting in a mortality of about 80%.2,3 Technical aspects such as quality cardiopulmonary resuscitation (CPR)4 and adherence to advanced cardiovascular life support protocols5 have been linked to better outcomes, but less is known about how nontechnical factors such as team leadership and communication may improve survival.6-11 Evidence from cardiac arrest simulation literature suggests that the absence of leadership and of clearly defined roles is associated with negative outcomes.7-12

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