Standardizing post-cardiac arrest care across rural–urban settings – qualitative findings on proposed post-cardiac arrest learning community intervention

Abstract

Background: Standardization of post-cardiac arrest care between emergency department arrival and intensive care unit admission can be challenging, particularly for rural centers, which can experience significant delays in interfacility transfer. One approach to addressing this issue is to form a post-cardiac arrest learning community (P-CALC) consisting of emergency department (ED) and intensive care unit (ICU) physicians and nurses who use data, shared resources, and collaboration to improve post-cardiac arrest care. MaineHealth, the largest regional health system in Maine, launched its P-CALC in 2022. Objective: To explore P-CALC participants’ perspectives on current post-cardiac arrest care, attitudes toward implementing a P-CALC intervention, perceived barriers and facilitators to intervention implementation, and implementation strategies. Methods: We conducted semi-structured, individual, qualitative interviews with 16 staff from seven system EDs spanning the rural–urban spectrum. Directed content analysis was used to discern key themes in transcribed interviews. Results: Participants highlighted site- and system-level factors influencing current post-cardiac arrest care. They expressed both positive attitudes and concerns about the P-CALC intervention. Multiple facilitators and barriers were identified in regard to the intervention implementation. Five proposed implementation strategies emerged as important factors to move the intervention forward. Conclusions: Implementation of a P-CALC intervention to effect system-wide improvements in post-cardiac arrest care is complex. Understanding providers’ perspectives on current care practices, feasibility of quality improvement, and potential intervention impacts is essential for program development.