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Improving Resuscitation Quality and Outcomes Through More Frequent Training: The IVCH Story

Currently, most hospitals mandate that clinical staff update their CPR training every two years; however, when presented with evidence on the difference that more frequent training can provide, many hospitals are making the decision to adapt the AHA’s guidance on the frequency and mode of training.

Right now, healthcare educators may be experiencing a resuscitation dilemma. How will they communicate the science that makes it clear that the way that CPR training has been done and the frequency with which it has been done in the past are simply not effective? Moreover, how will they implement the new training at the recommended intervals without creating havoc in their training schedules and budgets? And lastly, can they accomplish the ambitious goal that the American Heart Association (AHA) has set for improving the Sudden Cardiac Arrest (SCA) survival-to-discharge rates from 19 to 38% by the year 2020?

Because of the rapid decay of CPR skills, hospitals are left with a significant challenge-how to preserve resuscitation skills and ensure that patients are receiving optimal care. The research suggests a need for much more frequent CPR training. What is the best way to insure that patient care providers are getting the recommended training at the recommended interval and how can hospitals adapt to the more frequent training requirements?

HeartCode RQI is the subscription-based AHA solution to address the problem of rapid CPR skills degradation after initial training. The program is a cloud-based, turnkey learning and training service from the AHA, with learning technology from Laerdal. The program includes cognitive components that are delivered online and psychomotor skills assessments that can be performed at mobile Simulation Stations. The stations are equipped with adult and infant manikins and a tablet computer that connects the student to the training material.

The IVCH Experience with RQI

Renee Rebholz, Director of Education at Illinois Valley Community Hospital (IVCH) in Peru, Illinois, which recently partnered with HealthStream on HeartCode RQI, shared her experience and that of IVCH with the implementation and introduction. Like her peers at small, rural hospitals, Ms. Rebholz works hard to insure that IVCH’s 700 employees receive the training and certifications that they need. She shared with us that in the past “It was very hard to maintain competency and ensure that patient care staff had unexpired CPR cards. The size of the hospital staff made training difficult—it was a challenge to provide coverage on the nursing units and departments while trying to provide the training every two years. Providing it on a more frequent basis seemed a daunting task.”

Ms. Rebholz offered that it was a struggle to get enough classes done at the right time and that it was difficult to find the time to do the training in addition to her other jobs. She frequently had to make time to do additional training for the hospital-owned physician office practices and other off-site organizations that are owned by the hospital. Additionally, one-on-one training was frequently necessary. More importantly, Ms. Rebholz also noticed something that the new AHA Guidelines and research have quantified—“our staff felt as if they weren’t skilled enough because (with the exception of the ER and the ICU) they weren’t using the skills often enough during the two year training intervals. There was a level of learning that we were losing and we could see that as we conducted our training.”

RQI Produces Results

While it is still too early to completely quantify clinical results (both hospitals began their programs in January 2016), IVCH has surveyed the program’s participants in an attempt to measure program efficacy and acceptance of the new training modality. Acceptance for the program is extraordinarily high. Ms. Rebholz shared that many nurses were actually shocked to learn that they had been doing compressions incorrectly. The VAM provides specific audio feedback on hand position, compression rate and depth and ventilation rate that an alternative CPR dummy simply cannot provide.

Implementation Lessons

The hospital began its program very recently and has some advice for hospitals who are considering implementing RQI. It trained a team of “super-users” that receive additional training and act as additional resources and advocates. They are planning an even larger role for their super-users in the future and recommend that hospitals begin their communication process around this training early and plan for a lot of it. They also recommend promoting the use of super-users early in the process to share the responsibility for the rollout. The mobile nature of the cart and well-trained super-users combined with shorter training sessions for students has resulted in a more time-efficient means of administering CPR certifications with a broader range of support for students.

The Destination

While the hospital is still in the early stages of its journey, it has already seen benefits:

  • Improved staff confidence and skill in CPR
  • High levels of staff acceptance of the new training modality thanks to the feedback provided by the VAMs and the compelling data from the AHA
  • Improved ability to provide training across shifts and locations thanks to the mobile nature of the HeartCode RQI tools
  • Skilled teams of unit-based super-users to provide additional training resources to staff


Lastly, RQI may also have some non-clinical benefits. Consumers want to know that their local hospital is providing great care based on the state-of-the-art in medicine. IVCH included information on their RQI program in HealthScene, the hospital’s community newsletter and also supplied articles on the topic to the local newspaper. In addition, Ms. Rebholz shared that “RQI makes it easier to recruit the best staff because they understand the importance of embracing best practices. It means a lot to the community too because they understand that this improves care–we are the only ones doing this in our marketplace. It makes us stand out.”

This article is taken from our recent complimentary RQI-focused eBook, Improving Outcomes Through Low Dose, High Frequency CPR Training. Download the eBook here.

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