Executive Summary Checklist

Reducing preventable deaths requires a multi-disciplinary, multi-specialty collaborative team. In order to implement a program that will optimize anticipation, identification and resuscitation (AIR) of at-risk patients, an implementation plan to complete the following actionable steps should be followed:

The Performance Gap

The Institute of Medicine 2001 report on quality in healthcare identified failure to rescue as a key opportunity for improving patient safety, decreasing preventable deaths, and reducing healthcare expenditures \cite{2001}. The recognition that many in-hospital deaths are preventable has resulted in a myriad of patient safety efforts targeting a variety of clinical scenarios and disease states. While some of these have demonstrated promise, hospitals are often overwhelmed with the selection, implementation, and coordination of these efforts. In addition, healthcare professionals are facing an increasing number of required training modules, but with a concerning lack of engagement in each. The segregation or “siloing” of these efforts limits their clinical effectiveness, effectively devolving them into a regulatory requirement driving so-called “compliance innovation” instead of a truly coordinated effort to improve clinical outcomes \cite{Blind}.
The ultimate consequence of failure to rescue is unexpected cardiopulmonary arrest \cite{Schmid_2007}. The primary mechanism for maintaining resuscitation competency remains the American Heart Association life support training courses: Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS)\cite{20956224}. These courses have several limitations, particularly for in-hospital providers \cite{23479672,or6}:
  1. ACLS/BLS curricula are heavily based on out-of-hospital cardiac arrest. However, recent evidence documents important differences between out-of-hospital and in-hospital arrest etiologies.
  2. ACLS/BLS curricula cannot be modified to address institutional continuous quality improvement (CQI) needs.
  3. Treatment algorithms upon which the ACLS/BLS courses are based cannot incorporate the variety of new technologies that offer tremendous potential to improve outcomes. Finally, there is no emphasis on arrest prevention, which is where the most opportunity exists for improving clinical outcomes in the hospital setting.
An institutional AIR  program should target preventable deaths for a particular hospital or healthcare organization.  Thus, each of the core elements described below (Steering Committee, Afferents, and Efferents) should reflect and be adapted to that institution.  In addition, the core elements should be linked together in an institutional closed-loop performance improvement system.

Advanced Resuscitation Training (ART)

Advanced Resuscitation Training (ART) was developed in 2007 at the University of California at San Diego (UCSD) and represents the archetype for an institutional resuscitation program. The ART program represents a comprehensive system of care that targets the reduction of preventable deaths in both the out-of-hospital and in-hospital environments.6 The ART model links scientific evidence, continuous quality improvement (CQI) data, technology, institutional treatment algorithms, and training (Figure 1). Ownership and accountability are transferred to the institution, enhancing both relevance and engagement.