Rates of in-hospital cardiac arrest vary widely across US institutions
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The incidence of in-hospital cardiac arrest among Medicare beneficiaries varied widely across U.S. hospitals, with the rates lowest in minor teaching hospitals and facilities with higher rates of nurse staffing, researchers reported.
Tyler P. Rasmussen, MD, PhD, chief fellow in the department of internal medicine at the University of Iowa, and colleagues analyzed in-hospital cardiac arrests among 4.5 million Medicare beneficiaries admitted to a U.S. hospital from 2014 to 2017.
During the study period, there were 38,630 cases of in-hospital cardiac arrest (mean age, 76 years; 43% women; 69% white), according to the researchers.
The median risk-adjusted incidence of in-hospital cardiac arrest was 8.5 (95% CI, 8.2-9) per 1,000 admissions, Rasmussen and colleagues wrote.
After adjusting for differences in case-mix index, the researchers determined that the incidence of in-hospital cardiac arrest varied from 2.4 per 1,000 admissions to 25.5 per 1,000 admissions (interquartile range, 6.6-11.4; median OR = 1.51; 95% CI, 1.44-1.58). The researchers wrote this means that “the relative odds that a hospitalized patient at one randomly selected hospital would experience an in-hospital cardiac arrest were 51% higher compared with a similar patient admitted at another randomly selected hospital with identical case-mix.”
Higher nurse staffing was associated with lower incidence of in-hospital cardiac arrest (OR = 0.96; 95% CI, 0.92-0.99; P = .007), as was hospital teaching status, with minor teaching hospitals linked to lower incidence of in-hospital cardiac arrest (OR = 0.74; 95% CI, 0.58-0.93).
“Although higher nurse staffing levels and teaching status were associated with a lower hospital incidence of in-hospital cardiac arrest, a majority of the hospital variation in in-hospital cardiac arrest incidence remained unexplained,” Rasmussen and colleagues wrote. “Further studies are warranted to better understand care delivery practices and systems of care in hospitals with low in-hospital cardiac arrest incidence to identify best practices for the prevention of in-hospital cardiac arrest.”
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