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Enhancing Patient Outcomes: ILCOR’s Ten Critical Steps

Enhancing Patient Outcomes: ILCOR's Ten Critical Steps

Photo of Greta

by Greta Kviklyte

Life Saver, AMC
Co-authored by Kim Murray, RN, M.S.

posted on Dec 24, 2023, at 5:11 am


In healthcare, where every second counts, the International Liaison Committee on Resuscitation (ILCOR) plays a pivotal role in shaping guidelines and recommendations to improve cardiac arrest outcomes. Recently, we delved into the latest ILCOR guidelines, highlighting updates on ACLS, CPR, PALS, and BLS content. Now, ILCOR has taken another leap forward in addressing the specific challenges of in-hospital cardiac arrests (IHCAs). In this article, we’ll explore the ten critical steps identified by ILCOR to enhance outcomes for patients experiencing cardiac arrest within the hospital setting.

ILCOR updates its guidelines every five years, incorporating new research findings and emerging best practices.

These updates are designed to ensure that healthcare professionals are equipped with the most current and effective life-saving techniques. The recent focus has extended beyond traditional guidelines, with a dedicated effort to improve in-hospital cardiac arrest quality of care.

Ten Essential ILCOR Steps for Better Outcomes

healthcare professionals discussing cprILCOR recognizes that an in-hospital cardiac arrest is a high-risk event associated with significant morbidity and mortality. To address this challenge, they’ve identified ten crucial steps that, when implemented, can lead to better patient outcomes and survival. These steps are grouped into four categories: Plan and Prepare, Prevent, Perform, and Principles and Culture.

Plan and Prepare

Step 1: Build and Support Governance and Infrastructure for a Resuscitation Program

Building a resilient governance structure, backed by administrative leadership committed to resuscitation excellence, lays the foundation for improving IHCA survival rates. Resuscitation care involves a multitude of structures and processes, including proper equipment, well-trained healthcare professionals, and a prospective resuscitation database. When these elements are harmoniously integrated, they form an efficient system of resuscitation care that yields better patient outcomes.

Strategies for Implementation:

  • Local Operational Champions: Identify passionate individuals with the authority to oversee resuscitation programs. These champions can advocate for change and secure resources for essential equipment, training, and evidence-informed protocols.
  • Supportive Infrastructure: Develop policies and infrastructure to support quality care. Effective leaders and teams should comprise multiple disciplines and hospital departments, fostering a culture of continuous improvement.

Step 2: Collect Data to Measure and Improve Resuscitation Processes and Outcomes

The axiom “you cannot improve what you do not measure” holds particularly true in healthcare. Effective measurement is pivotal for performance management and quality enhancement. While it’s essential to measure cardiac arrest occurrences and survival outcomes, IHCA data collection should encompass the entire continuum of resuscitation care. This broader approach enables performance assessment and identifies areas ripe for improvement.

Strategies for Implementation:

  • Buy-In and Resources: Obtain support from hospital leadership and resuscitation stakeholders. IHCA data collection requires resources and dedicated personnel.
  • Tailored Data Collection: Customize data collection efforts to align with institutional priorities and available resources. Start with core variables and escalate data collection gradually.
  • Patient Identification and Real-Time Collection: Develop consistent processes to identify patients at risk for or experiencing IHCA. Collecting data in real time can be challenging but is crucial for accuracy.

Step 3: Implement Effective Education and Training for Resuscitation

To save lives during IHCA, it’s imperative to provide comprehensive resuscitation education and training programs for all hospital staff. These programs should adhere to guidelines, be tailored to individual needs, and encompass various learning formats, from in-person courses to online learning. Moreover, they should emphasize team competencies and hands-on practice of essential skills.

Strategies for Implementation:

  • Leadership Support: Strong leadership backing with resource allocation is essential for successful education and training. Prioritize resuscitation education and share clinical cardiac arrest data.
  • Needs Assessment: Identify knowledge gaps and skill deficiencies among hospital staff through a needs assessment.
  • Train-the-Trainer Approach: Enable highly skilled employees to become trainers for larger groups.
  • Continuous Improvement: Incorporate real-time feedback, such as CPR coaching, and debriefing sessions into training. Use IHCA outcomes data to drive continuous quality improvement.


Step 4: Establish Patient and Family Goals of Treatment Early and Reassess Often

Effective communication and shared decision-making play a pivotal role in patient-centered care, particularly in the context of emergency treatment decisions such as resuscitation. Ideally, discussions regarding goals of treatment should initiate before hospital admission, involving patients, their primary care practitioners, and the consideration of advanced directives. Upon admission, it’s vital to revisit and establish clear goals of treatment, including emergency procedures like CPR, considering that not all patients may wish to undergo resuscitation efforts.

During a patient’s hospital stay, the goals of treatment should be regularly reassessed. Factors such as changes in patient preferences, evolving clinical conditions, or transfers to different care settings necessitate this ongoing evaluation. This continuous assessment extends to the effectiveness of ongoing therapies and the consideration of life-sustaining treatment withdrawal when appropriate. Encouraging open and informed discussions about treatment goals between patients, families, and healthcare professionals is fundamental to delivering patient-centered care that respects individual preferences and values.

Strategies for Implementation:

  • Structured communication tools can significantly enhance the quality of these discussions and the documentation of patient wishes and treatment plans. ILCOR recognizes that hospital staff should receive training in the use of such tools, ensuring that these critical decisions are accessible and transferrable within and between care settings. In cases where organ donation is appropriate, staff should be trained to handle the interface with the patient’s family.
  • Culturally sensitive materials and collaborative decision-making models that involve families, community leaders, and healthcare professionals should be employed to respect cultural values and preferences while honoring individual patient wishes, including the option of family presence during resuscitation.

Step 5: Stop Preventable IHCA

Preventing IHCA is a critical step towards reducing hospital morbidity and mortality. While not all IHCAs are predictable or preventable, having a systematic approach to halting preventable IHCAs is paramount for saving lives. Achieving this requires the establishment of systems and teams focused on early prediction, identification, and response to deteriorating patients. Effective communication methods to ensure a clear plan and safe transition of care are also essential.

Published rates of preventable IHCA vary, highlighting the need for prioritization within hospital cardiac arrest and quality improvement committees. One approach recommended by ILCOR is the introduction of a rapid response system to support deteriorating patients and reduce the incidence of IHCA. However, despite some debate on their effectiveness, early warning scoring and rapid response systems remain global patient safety recommendations.

Strategies for Implementation:

  • Implementing rapid response systems is a complex endeavor. Evidence suggests that high-performing systems are staffed by dedicated, multidisciplinary teams working collaboratively with bedside teams. Such systems foster a culture of safety that enables swift activation without concerns about reprisal. The operation should be round-the-clock, with consideration given to involving other teams in decisions on resuscitation when shared decision-making is challenging.
  • Tools ensuring early detection of deteriorating patients. Vital sign abnormalities and clinician concerns often drive the escalation of care to prevent IHCA. Therefore, regular measurement and interpretation of vital signs are crucial in IHCA prevention. Some healthcare facilities are exploring the integration of machine learning-based and artificial intelligence-powered systems to facilitate early detection of deteriorating patients.


Step 6: Develop and Deploy an Effective Resuscitation Response System

healthcare professional studying cpr online using laptopIn the world of cardiac arrest, every second counts. Prompt detection and immediate intervention can significantly improve a patient’s chances of survival. To achieve this, hospitals need to establish a comprehensive resuscitation response system that can be rapidly activated when needed. This system should include a high-quality resuscitation team composed of preassigned, experienced, and interdisciplinary healthcare professionals.

Recent studies have highlighted successful strategies for implementing such teams in hospitals, consistently achieving high IHCA survival rates. These strategies involve dedicated and designated resuscitation teams with clear roles and responsibilities for each team member. Effective communication and leadership during IHCA are crucial components of these high-performing teams. Additionally, empowering frontline healthcare professionals with training and mentoring plays a significant role in their success.

Strategies for Implementation:

  • To effectively implement a resuscitation team, hospitals should ensure that the team can be rapidly deployed to a patient in cardiac arrest. Emergency plans should be in place to bring necessary equipment like defibrillators, emergency drugs, and airway management tools to the patient’s bedside. All initial responders should be trained to initiate CPR immediately.
  • The composition of the resuscitation team is crucial. Ideally, it should include medical staff and nurses, as well as other healthcare professionals as appropriate. Members of the team should be preassigned and readily available for immediate response. While some institutions may have team members solely dedicated to responding to cardiac arrests and emergencies, this model may not be universally applicable. However, it is vital to have clear team leadership and well-defined roles, including who will perform chest compressions, provide defibrillation, and manage the airway, before or early during a cardiac arrest event. Effective leadership, closed-loop communication, and mutual respect are essential for highly effective resuscitation teams.

Continuous education and training efforts should go beyond traditional cardiac arrest algorithm training to ensure that resuscitation teams are well-prepared for their critical role.

Step 7: Deliver Guideline-Based Resuscitation Care

In-hospital cardiac arrest response relies on adhering to established guidelines for high-quality resuscitation care. Key components include prompt initiation of CPR and defibrillation when needed, monitoring CPR quality, swift rhythm analysis, cause-directed interventions, and cautious termination of resuscitation.

Strategies for Implementation:

  • Ensure all healthcare professionals receive rigorous training in CPR and adhere to resuscitation guidelines.
  • Maintain timely access to defibrillators and continuous education for staff.
  • Use capnography and feedback tools to monitor and optimize CPR quality.
  • Perform rhythm analysis and defibrillation swiftly, as delays lower survival rates.
  • Administer medications like epinephrine and ensure proper ventilation.
  • Avoid premature termination of resuscitation efforts.

Step 7 underscores the critical importance of following established resuscitation guidelines in IHCA situations. By prioritizing guideline-based care and ongoing education, hospitals can significantly improve the chances of successful resuscitation and better outcomes for patients.

Step 8: Deliver Guideline-Based Postcardiac Arrest Care

Post-cardiac arrest care is a multifaceted process that begins as soon as return of spontaneous circulation (ROSC) is achieved. This care involves a multidisciplinary team addressing various aspects of the patient’s recovery, including physiological, psychological, and stress-related factors. The composition of the team may vary based on clinical context and available resources, but all members should have a clear understanding of contemporary guidelines and institutional protocols to provide guideline-based care.

This approach to care extends beyond the intensive care phase and continues into the ward, rehabilitation hospital, or home setting. It involves engaging, monitoring, and supporting the patient’s family and community as active team members. Additionally, palliative care and organ donation services should be incorporated when appropriate, based on individual patient needs and clinical context.

Strategies for Implementation:

  • Accurate assessment and communication of the patient’s prognosis at different intervals after ROSC are essential for preparing families and caregivers for potential outcomes. These prognostic discussions also inform decisions about life-sustaining treatments. Population statistics based on patient demographics and arrest characteristics can provide a general idea of prognosis, but individual-level prognostication in the early period after ROSC is limited and typically deferred under current guidelines.
  • Prognostication accuracy is dependent on various factors, including the modalities used, timing of measurements, and potential confounding factors. It is recommended that hospitals use more than one validated predictor of poor neurological outcomes when making decisions about limiting life-sustaining therapy, as no single modality is 100% accurate.
  • Patients who have been resuscitated from out-of-hospital cardiac arrest and meet circulatory or brain death criteria are potential multiple-organ donors. While there is a knowledge gap regarding organ recovery following IHCA, there is potential for appropriate referrals for organ donation in cases of circulatory or brain death after achieving ROSC. It is essential to consider cultural and legal considerations when addressing organ donation in these situations.

Principles and Culture

Step 9: Implement a Person-Centered Culture of Excellence in Care

Incorporating a person-centered approach involves effective, culturally sensitive communication with patients and families. Engaging them in shared decision-making and ensuring their goals, values, and preferences are considered. For survivors, developing post-discharge plans and offering bereavement support to families are crucial components.

Strategies for Implementation:

  • Plan regular meetings with patients and families to discuss treatment goals.
  • Provide written information and counseling support for families of nonsurvivors.
  • Create comprehensive discharge plans tailored to survivors’ physical, psychological, and social needs.
  • Facilitate connections with peer support networks for survivors.

This step emphasizes the importance of person-centered care, acknowledging cultural differences, and fostering open communication with patients and their families.

Step 10: Ensure the Well-Being of Health Care Professionals

Addressing the well-being of healthcare professionals is vital, considering the psychological, physical, and spiritual challenges they face during resuscitations. Support mechanisms, such as psychological counseling, mentorship, spiritual guidance, and debriefing sessions, are essential for sustaining the care team’s emotional and physical health.

Strategies for Implementation:

  • Routinely assess the emotional state of healthcare staff and offer psychological and spiritual support.
  • Provide coaching, mentorship, and peer support programs.
  • Conduct debriefings to address staff well-being and identify those in need of additional support.

ILCOR highlights the significance of caring for healthcare professionals’ well-being, ensuring they can provide high-quality care while safeguarding their own mental and emotional health.

Leading the Way

In the dynamic world of healthcare, staying at the forefront of medical advancements is paramount. ILCOR’s ten crucial steps provide a roadmap for enhancing in-hospital cardiac arrest outcomes and elevating care quality. From proactive planning to healthcare professional well-being, these steps encapsulate excellence in IHCA management.

At Advanced Medical Certification, we are committed to delivering the latest knowledge and resources to empower healthcare professionals. Visit our platform for updates, articles, and courses designed to keep you informed and skilled. By embracing cutting-edge methods and technologies, we collectively enhance patient care, instill trust, and save lives.

About Greta

Greta is a dedicated life saver and a distinguished expert in the field of medical content creation and editing. Her impressive array of certifications in ACLS, CPR, PALS, and BLS underscores her commitment to excellence in the medical field. With over four years of invaluable experience in medical education, Greta plays an indispensable role within the Advanced Medical Certification team, shaping the way healthcare professionals around the world acquire and apply vital knowledge.

Greta's profound expertise serves as the driving force behind the development and distribution of medical content that has significantly enhanced the capabilities of countless healthcare practitioners across the globe.

In addition to her medical qualifications, Greta holds a prestigious academic distinction in Marketing and Global Business from Vilnius University. Her academic journey has been enriched by immersive studies in Slovakia and Portugal during her time as an exchange student, providing her with a global perspective that complements her medical expertise.

Beyond her professional commitments, Greta possesses a genuine passion for global exploration, with a particular focus on immersing herself in diverse cultures and appreciating the intricacies of the natural world. While residing in Vilnius, Lithuania, she continues to make substantial contributions to the field of medical education, leaving an indelible mark on the sector.

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