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Challenges for Resuscitation across the Care Continuum

Where and how healthcare is delivered has changed significantly in recent years—the trend towards shorter inpatient stays and more frequent transfers from hospitals to alternative care settings is likely to continue. “As more healthcare is delivered outside the walls of acute-care hospitals, we must understand that leaders across the care continuum need to move beyond the traditional activity of simply getting CPR cards and really invest in the kind of training that their employees need—the kind of training that saves lives and improves outcomes,” states Donna Haynes, a former National Resuscitation Coach at HealthStream.

Why is improving resuscitation so important for the care continuum? It’s no secret that resuscitation rates are grim across the spectrum of healthcare. In continuum care settings, they range from a shocking 2 to 11 percent, which is much more dire even than that in hospitals, where survival rates still range from a paltry 18 to 24 percent. Even when a victim does survive, nearly one in two will have newly developed impairments as a result of cardiac arrest. Both acute- and continuum care organizations are challenged to improve resuscitation rates while also maintaining patient functionality afterwards.

Challenges for Resuscitation across the Care Continuum

It is important to understand that the continuum of care encompasses a vast array of settings, including home health, hospice, ambulatory surgery centers, dialysis centers, behavioral health facilities, long-term care, assisted living facilities, and clinics. Care varies widely across the continuum from a traditional hospital environment, and these settings face unique challenges, including:


  • Varying states of acuity among patients and residents - Haynes points first to the most obvious challenge for resuscitation across the continuum, which is that the acuity of patients can vary widely by setting. Although codes are more common in acute-care settings, patient acuity levels are climbing and becoming more complex in continuum care settings, creating an increased need to improve resuscitation training.


  • A wide range of lengths of stay - Patients may stay one day to one week for an outpatient procedure or up to several months at a long-term/residential care facility.


  • Inconsistent knowledge at provider of patient medical history - Due to the varying lengths of stay, the staff may not have full knowledge of the patient’s medical history. For example, less is typically known about the patient in an ambulatory surgery center prior to a procedure than would be known in an acute-care setting.


  • High Rates of Staff Turnover - Employee turnover is high in some of these settings, which makes it difficult to keep staff competent to respond to a Code. The constant flow of new staff members creates a workforce with varying degrees of preparation and comfort with what is required in resuscitation.


  • Infrequent Codes - The good news is that Codes occur much less frequently in these continuum care settings. But that’s also the bad news! CPR skills that are refreshed just once every two years are unlikely to result in high-quality, life-saving CPR. In 2015, the resuscitation guidance to healthcare providers on CPR training was updated. As Alex Harris, HealthStream Solution Executive for Resuscitation, puts it, “If you don’t use it, you lose it.” CPR skills begin to decay in as little as three months, which leaves a significant gap between the recommended training interval—every three months—and the current process in most healthcare settings—once every two years. Harris adds, “Just like their acute-care counterparts, providers across the continuum of care need to receive the highest quality CPR training available and to receive it in a way that is easily accessible and readily available at all times.”

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