English, Pdf

Copy and paste this link to your website, so they can see this document directly without any plugins.



Keywords

AEDs, hospitals, used, were, installed, areas, that, commonly, hospital, with, hospitals,, medical, outcomes, AEDs,, defibrillators, patients, number, Total, also, reported, total, Japan, been, surveyed, resuscitation, those, external, automated, their, only

Transcript

21www.signavitae.com
Utilization of automated
external defibrillators
installed in commonly used
areas of Japanese hospitals
ABSTRACT
Objective. Since July 2004, it has become legal in Japan for laypersons to use automated external defibrillators (AEDs). We
investigated the effect of AED installation in commonly used areas of Japanese Association for Acute Medicine accredited
training (JAAM) hospitals.
Methods. In 2008, we sent questionnaires to 419 JAAM hospitals enquiring about the systems, operations, outcome and
characteristics of AED usage.
Results. Valid responses were received from 271 hospitals (64.7%). A total of 251 (92.8%) hospitals installed AEDs, mostly
in the outpatient departments. These AEDs could also be used by laypersons. Operational responsibility was mostly
assumed by the medical emergency center staff. The Engineering Department was in charge of AED maintenance. Of the
surveyed hospitals, 65.5% reported having guidelines for usage. The percentages of hospitals which kept records of AED
use and outcomes were low. A total of 66.2% reported having a rapid response team and 98.1% provided a non-standardized resuscitation education program. In 68.3% of hospitals, an AED had been used. AEDs were used not only by medical
doctors but also by other health professionals. Among the patients who received AED defibrillation, 42.5% survived without
neurological deficit.
Conclusion. The utilization of AEDs, installed in commonly used areas of JAAM hospitals, has shown beneficial and effective outcomes for improving the resuscitation and survival of patients who experience in-hospital cardiac arrest. AEDs can
be used not only by doctors but also by laypersons, making them more accessible and useful. The strategic installation of
AEDs can make hospitals safer.
SHOICHI OHTA (  )
HIROYUKI NAKAO •
SHIGEKI KUSHIMOTO •
ATSUSHI HIRAIDE •
TETSUYA SAKAMOTO •
KEN NAGAO •
SHINGO HORI
Japanese Association for Acute Medicine
Life Support Committee (2007-2008)
Hiroshi Takyu
Department of Rehabilitation
Chubu Gakuin University, Gifu, Japan
Department of Emergency
and Critical Care Medicine
Tokyo Medical University Hospital
6-7-1 Nishishinjuku, Shinjuku, Tokyo, Japan
Phone: +81-(0)3-3342-6111 (ex. 5780)
Fax: +81-(0)3-3342-5687
E-mail: sho-ohta@tokyo-med.ac.jp
SHOICHI OHTA • HIROSHI TAKYU • HIROYUKI NAKAO •
SHIGEKI KUSHIMOTO • ATSUSHI HIRAIDE • TETSUYA SAKAMOTO •
KEN NAGAO • SHINGO HORI
ORIGINAL
SIGNA VITAE 2013; 8(1): 21 - 24
Key words: automated external defibrillators, commonly used areas, inhospital
Introduction
The use of manual defibrillators in hospitals in Japan is restricted to medical
doctors. Since July 2004, it became
legal for lay persons to use an automated external defibrillator (AED). The
number of AEDs installed in public
areas (public access defibrillators
[PAD]), including medical and nursing
facilities has increased recently, and
it has been reported that the use of
PADs has significantly improved lifesaving rates. Japan was the first country to confirm the effectiveness of a
nationwide PAD system. (1) In Japan,
AEDs are installed in commonly used
areas in hospitals, for example, elevator
halls, entrance halls and waiting areas.
In hospitals, manual defibrillators are
used only by medical doctors. On the
other hand, these AEDs can be used
not only by hospital personnel but also
by outpatients and their family members. However, even with the reported
widespread success rates of AEDs,
(1) systematic research on how AEDs
22 www.signavitae.com
installed in commonly used areas of
hospitals are managed and used has
been scarce.
In this study, we investigated the utilization of AEDs in commonly used
areas of Japanese Association for
Acute Medicine (JAAM) - accredited
training hospitals, which include most
representative teaching hospitals in
Japan. JAAM, founded in 1973, is the
first medical association for emergency
medicine in Japan. JAAM membership now exceeds 10,000. In the 1980s,
JAAM organized a specialty board. In
2010, JAAM had 3,035 board-certified
emergency physicians. (2)
Methods
In 2008, questionnaires were sent to
419 JAAM-accredited training hospitals
- 4 years after AEDs were authorized for
general use. The survey consisted of
questions covering systems and operations, including the date on which an
AED was installed, and the identification of operators. In the questionnaire,
we also asked if the institution had guidelines for the use of AEDs, a record of
use, whether the outcomes of the use
of an AED were recorded, whether the
institution had a rapid response team,
and whether instructions for resuscitation were provided. The succeeding
questions focused on the outcomes
and characteristics of AED use.
Data analysis was performed using JMP
software (Version 9.0.1; SAS Institute,
Cary, NC, USA) and included calculating descriptive indicators of AED use
in hospitals. Furthermore, the trends
of AED use by operating years and the
number of hospital beds were compared using the Cochran Armitage test for
trend. Furthermore, respondents were
assigned into 4 different survey groups
based on the number of installed AEDs,
existence of guidelines for AEDs, existence of a system for recording their
use as well as the outcomes of their
use. Associated unadjusted odds ratios (OR) and confidence intervals (CI)
were calculated.
Results
We analyzed the valid responses obtained from 271 training hospitals (64.7%).
A total of 251 (92.8%) hospitals installed
AEDs. In 83.9% of the surveyed hospitals, not only hospital personnel but
also laypersons could use installed
AEDs. Operational responsibility was
assumed by the medical emergency
center staff (18.8%) and safety management officers (15.2%). The Engineering Department was in charge of
the maintenance of AEDs (57.5%). A
total of 65.5% of the surveyed hospitals
reported having guidelines, whereas
the percentage of surveyed hospitals
with records of AED use and records of
outcomes of use was low (35.6% and
32.5%, respectively). A total of 66.2%
of surveyed hospitals reported having
a rapid response team and 98.1% provided a non-standardized resuscitation
education program covering various
topics. In 68.3% of surveyed hospitals,
an AED had been used. Operators were
mainly healthcare professionals, the
majority of whom were medical doctors
(44.3%). Of the patients who received
defibrillation with an AED in the 271 training hospitals, 42.5% of patients were
resuscitated relatively quickly and survived without any neurological deficit.
We found that the frequency of AED use
increased if a hospital had a large number of installed AEDs and had systems
for recording its use and outcomes.
We also found that if a hospital had a
small number of beds and few weekday
patients, then that institution had significantly less frequent use of AEDs.
Based on the assignments of respondents into 4 different survey groups,
the following results were obtained:
(a) those who work in a hospital with
1 to 5 installed AEDs (unadjusted OR,
8.57; 95% CI, 4.56-16.10), (b) those
who work in a hospital which has no
guidelines for using AEDs (unadjusted
OR, 1.71; 95% CI, 0.98-3.00), (c) those
who work in a hospital which has no
system of recording the use of AEDs
(unadjusted OR, 11.38; 95% CI, 4.6827.67), and (d) those who work in a
hospital with a system to record AED
use outcomes (unadjusted OR, 5.84;
95% CI, 2.51-13.59) (table 1). When
the trend of installation and the use of
AED according to year were examined,
significant increases in the number of
AEDs installed and the frequency of
AED use were observed from 20022005 (p<0.0001). Also, a significant
increase in the frequency of AED use
was observed (p=0.0017) with an
increase in the number of hospital beds
from < 450 beds to > 650 beds (table
2). However, the frequency of AED use
according to year did not significantly
differ among the hospitals surveyed.
Discussion
We set out to investigate the systems,
operations, outcomes and characteristics of AED utilization, installed in
commonly used areas of hospitals in
Japan to clarify their overall impact
on making hospitals safer. Since the
use of manual defibrillators in Japan
is restricted to medical doctors, AEDs
have been installed in many facilities, particularly those specializing in
acute care medicine (e.g., critical care
units or operating rooms). Our survey
showed that AEDs, installed in commonly used areas of hospitals, can be
used by hospital personnel (mostly nurses and other medical professionals)
besides medical doctors, as well as by
laypersons. Furthermore, since their
operation involves the participation and
cooperation of several departments,
this system may facilitate interactions
among different departments and help
promote team-based care. Although it
has been reported that the life-saving
rate has decreased with the use of AEDs
in the United States and other countries, it is difficult to compare the results
of such studies with those in Japan, as
the surrounding environments are very
different. (3) In this survey, we have
shown that patients in more than 40%
of institutions who were treated with
an AED were able to return to normal
life relatively quickly. Apart from doctors (who formed the majority), many
nurses used AED. (4) Because nurses
are the first to notice deterioration in
a patient’s condition, it is possible to
shorten the length of time that patients
are exposed to the effects of cardiac
diseases, such as cardiopulmonary
23www.signavitae.com
arrest (CPA), if the nurses are the AED
operators. This way, more patients can
be resuscitated and are likely to survive without developing any neurological deficits, within a relatively shorter
timeframe than previously reported.
(5,6) However, in the current study, we
neither obtained nor compared data
regarding patient conditions before and
after the introduction of AEDs, or their
use or non-use or resuscitation rate, nor
did we ascertain the number of patients
who were able to survive without developing any neurological deficits within
a reasonable timeframe. Nevertheless, the results suggest that the use of
AEDs, for resuscitation in hospitals,
has a direct effect on a patient’s discharge, with no complications of neurological disability. Thus, we consider that
the installation of AEDs in commonly
used areas of hospitals can be highly
beneficial. Moreover, onsite AED use
was associated with higher survival
rates than dispatch AED use. AEDs that
are installed in commonly used areas
may shorten the time to defibrillation
since these AEDs can be used even
by laypersons. AEDs that are installed
in commonly used areas of hospitals
are positioned between onsite AED use
and dispatch AED use. (7)
As mentioned earlier, in hospitals with
Table 1. Unadjusted odds ratios (ORs) and 95% confidence intervals (95% CI) according to the four categories of
automated external defibrillators (AED) use obtained using the logistic regression model.
Survey group Total Use of AED Unadjusted
N % OR 95% CI
Installed AEDs total 228 155 0,68
1-5 84 33 0,39 1,00
6- 144 122 0,85 8,57 4,56 16,10
Guidelines for using AEDs Total 241 164 0,68
No 83 50 0,60 1,00
Yes 158 114 0,72 1,71 0,98 3,00
System of recording the
use of AEDs Total 240 164 0,68
No 153 83 0,54 1,00
Yes 87 81 0,93 11,38 4,68 27,67
System of recording AED use
outcomes
Total 227 162 0,71
No 153 95 0,62 1,00
Yes 74 67 0,91 5,84 2,51 13,59
*A total of 251 hospitals installed AEDs.
Table 2. Trend of installation and use of automated external defibrillators (AED) according to year and number of
hospital beds.
Survey group Total Use of AED P-value*
installations N %
Year of AED operation Total 228 164 0,72
2002 13 11 0,85
2003 33 32 0,97
2004 53 44 0,83 p < 0.0001
2005 62 46 0,74
2006 49 26 0,53
2007 18 5 0,28
Number of hospital beds Total 259 177 0,68
<430 81 43 0,53
<650 87 65 0,75 p = 0.0017
>650 91 69 0,76
* P-value was determined using the Cochran Armitage test for trend.
24 www.signavitae.com
REFERENCES
1. Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A. Implementation Working Group for the All-Japan Utstein Registry of the Fire
and Disaster Management Agency. Nationwide public-access defibrillation in Japan. N Engl J Med 2010;362:994-1004.
2. Hori S. Emergency medicine in Japan. Keio J Med 2010;59:131-9.
3. Smith RJ, Hickly BB, Santamaria JD. Automated external defibrillators and survival after in-hospital cardiac arrest: early experience at an Australian teaching hospital. Crit Care Resusc 2009;11:261-5.
4. Heng KW, Fong MK, Wee FC, Anantharaman V. The role of nurses in the resuscitation of in-hospital cardiac arrests. Singapore Med J
2011;52:611-5.
5. Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival.
Intensive Care Med 2007;33:237-45.
6. Chan PS, Krumholz HM, Nichol G, Nallamothu BK; American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med 2008;358:9-17.
7. Berdowski J, Kuiper MJ, Dijkgraaf MG, Tijssen JG, Koster RW. Survival and health care costs until hospital discharge of patients treated with
onsite, dispatched or without automated external defibrillator. Resuscitation 2010;81:962-7.
ACKNOWLEDGEMENTS
We are indebted to Associate Professor Edward F. Barroga and Professor J. Patrick Barron, Chairman of the Department of International
Medical Communications of Tokyo Medical University, for their editorial review of the English manuscript.
more AEDs, records of use, and outcome assessment systems, AEDs are
used more often than in hospitals with
fewer AEDs. However, merely providing AEDs and establishing such a
system does not guarantee an increase in their use. Furthermore, it has
been shown that management and
instructional systems for AED use are
already in place at many medical institutions. Further studies should be conducted to investigate the use of AEDs
by encouraging the Plan, Do, Check,
Act cycle, which enables the creation
of a standardized instructional system,
conducting post-treatment investigations based on records of use, and
providing feedback to the first responders and the acute medicine team. In
this way, hospital safety may be further
improved.
We believe that this preliminary report
can provide baseline data for future
studies to show that AED installation
in commonly used areas of hospitals
may effectively increase the number of
resuscitated patients who experience
in-hospital cardiac arrest.
Limitations
In this study, we were not able to obtain
and compare data regarding patient
conditions before and after the use of
AEDs, or their use or non-use or patient
resuscitation rate. We were also unable
to ascertain the number of patients who
returned to normal life within a reasonable timeframe.
Conclusions
The utilization of AEDs installed in commonly used areas of hospitals may be
beneficial and effective for the rapid
resuscitation and eventual survival of
patients who experience in-hospital
cardiac arrest. The establishment of a
completely standardized resuscitation
system, including a report and verification system after AED usage, and the
development of standardized instructions for cardiopulmonary resuscitation
in hospitals using AEDs by hospital
employees and all hospital users can
potentially increase hospital safety.

PDF Document reader online

This website is focused on providing document in readable format, online without need to install any type of software on your computer. If you are using thin client, or are not allowed to install document reader of particular type, this application may come in hand for you. Simply upload your document, and Docureader.top will transform it into readable format in a few seconds. Why choose Docureader.top?

  1. Unlimited sharing - you can upload document of any size. If we are able to convert it into readable format, you have it here - saved for later or immediate reading
  2. Cross-platform - no compromised when reading your document. We support most of modern browers without the need of installing any of external plugins. If your device can oper a browser - then you can read any document on it
  3. Simple uploading - no need to register. Just enter your email, title of document and select the file, we do the rest. Once the document is ready for you, you will receive automatic email from us.

Previous 10

Next 10