EFFECT OF ADVANCED CARDIAC LIFE-SUPPORT TRAINING IN RURAL, COMMUNITY HOSPITALS

Objectives: To define the effectiveness of training personnel in rural, community hospitals in advanced cardiac life support (ACLS) and the changes that result in the process and quality of care to patients with ischemic heart disease that can be attributed to participation by team members in an ACLS course. Design: Case-controlled, retrospective abstraction of hospital records of 869 consecutive patients with ischemic heart disease, who were admitted during the year preceding and the year following the ACLS course. Setting: Seven rural, community hospitals in Wisconsin. Subjects: Physicians, nurses, and other critical care staff (others). Interventions: Training in ACLS using 12 3 hr sessions in an interdisciplinary format by a multidisciplinary faculty. Measurements and Main Results: Rates of successful attainment of the terminal behavior objectives by physicians and nurses were 84.0% and 78.8%, respectively. Less than 50% of others achieved a satisfactory level of competence, Performance on an examination of cognitive ability improved significantly for all groups (p < .005 for nurses; p < .05 for physicians). Enhancement of knowledge base and integrative skills occurred in all areas of designated ACLS content. Difficulty remained apparent relative to the pharmacologic effects of epinephrine and atropine. No statistically significant deterioration in didactic knowledge base could be detected 1 to 2 yrs after completion of the ACLS course. Slight deterioration in intubation and defibrillation skills occurred in <3 months after completion of the course. Substantial costs were encumbered by the hospitals, despite the free training provided to the institutions. After ACLS training had been given, overall mortality rates decreased from 17.4% to 13.4% (p < .05). A pooled estimate of the decrease in the mortality rate was 1.4 +/- 3.8%/quarter. Across the entire spectrum of severity of illness, the probabilities for survival increased at a given severity of illness following completion of the course (p = .06). When extremes of severity of illness were excluded from the analysis, the differences in probability for survival over the midrange of severity were statistically significant (p < .05). Conclusions: Training directed to the entire team likely to participate in the provision of ACLS in the community hospital favorably affects the overall practice of ACLS and the survival rate of patients with ischemic heart disease.