Effect of advanced cardiac life-support training in rural, community hospitals

OBJECTIVESTo 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. DESIGNCase-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. SETTINGSeven rural, community hospitals in Wisconsin. SUBJECTSPhysicians, nurses, and other critical care staff (others). INTERVENTIONSTraining in ACLS using 12 3-hr sessions in an interdisciplinary format by a multidisciplinary faculty. MEASUREMENTS AND MAIN RESULTSRates 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