Background: Hospitals participating in the Get With The Guidelines-Resuscitation registry for in-hospital cardiac arrest (IHCA) are recognized for high adherence rates (≥85%) for 4 quality metrics. However, the relationship between hospital recognition on resuscitation quality measures and IHCA survival is unknown.
Methods: Hospitals with ≥85% compliance for all 4 metrics for IHCA (time to chest compressions <1 minute; time to defibrillation <2 minutes; device confirmation of endotracheal tube placement; and a monitored or witnessed arrest) for at least 12 consecutive months during 2014-2015 were identified. The associations between hospital recognition for resuscitation quality measures and its risk-standardized survival rate (RSSR) for IHCA during the recognition period (Jan 1, 2014 - Dec 31, 2015) and during a preceding 2-year period (Jan 1, 2012 - Dec 31, 2013) were evaluated using Spearman’s point-biserial correlation.
Results: Between 2012 and 2015, data were available for 195 hospitals with continuous participation. Of these, 78 (40.0%) were recognized for high adherence to all 4 performance metrics for ≥1 year. There were no differences in site characteristics (teaching status, hospital location, bed-strength, or availability of specialty cardiac or intensive care services) between recognized and non-recognized hospitals. There was no association between hospital recognition based on resuscitation quality measures in 2014-2015 and hospitals’ RSSR during 2014-2015 (Spearman’s r=0.13, P-value 0.06). Similarly, there was only a weak association between recognized hospitals for resuscitation performance in 2014-2015 and their RSSR in the preceding 2-year period during 2012-2013 (Spearman’s r=0.16, P-value 0.03). Among hospitals in the highest tertile for RSSR for IHCA in 2014-2015, 36 out of the 65 (55.4%) hospitals did not meet recognition criteria for resuscitation quality measures.
Conclusions: The current recognition mechanism within a national registry for IHCA is weakly associated with hospital survival. This suggests that recognition awards measure only one aspect of quality and may not adequately capture hospital performance on survival—the outcome of greatest interest to patients.