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 wit h ischemic heart disease that can be attributed to participation by te am members in an ACLS course. Design: Case-controlled, retrospective a bstraction of hospital records of 869 consecutive patients with ischem ic heart disease, who were admitted during the year preceding and the year following the ACLS course. Setting: Seven rural, community hospit als in Wisconsin. Subjects: Physicians, nurses, and other critical car e staff (others). Interventions: Training in ACLS using 12 3 hr sessio ns in an interdisciplinary format by a multidisciplinary faculty. Meas urements and Main Results: Rates of successful attainment of the termi nal behavior objectives by physicians and nurses were 84.0% and 78.8%, respectively. Less than 50% of others achieved a satisfactory level o f competence, Performance on an examination of cognitive ability impro ved significantly for all groups (p < .005 for nurses; p < .05 for phy sicians). Enhancement of knowledge base and integrative skills occurre d in all areas of designated ACLS content. Difficulty remained apparen t relative to the pharmacologic effects of epinephrine and atropine. N o statistically significant deterioration in didactic knowledge base c ould be detected 1 to 2 yrs after completion of the ACLS course. Sligh t deterioration in intubation and defibrillation skills occurred in <3 months after completion of the course. Substantial costs were encumbe red by the hospitals, despite the free training provided to the instit utions. After ACLS training had been given, overall mortality rates de creased from 17.4% to 13.4% (p < .05). A pooled estimate of the decrea se in the mortality rate was 1.4 +/- 3.8%/quarter. Across the entire s pectrum of severity of illness, the probabilities for survival increas ed 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 midrang e of severity were statistically significant (p < .05). Conclusions: T raining directed to the entire team likely to participate in the provi sion of ACLS in the community hospital favorably affects the overall p ractice of ACLS and the survival rate of patients with ischemic heart disease.