The effectiveness of ART is best reflected by the results achieved at UC San Diego Medical Center (see graph below). ART has reduced the incidence of cardiopulmonary arrest by almost 50 percent. This reduction in arrest frequency has occurred predominantly in the non-ICU environment where the current incidence of arrests is about one-quarter of baseline. These results support the IOM goals of reducing preventable arrests and fostering an environment of enhanced patient safety. For the remaining patients who suffer cardiopulmonary arrest, neurologically intact survival has more than doubled. Survival-to-discharge rates have been sustained at a level more than twice that of the benchmark established by the American Heart Association’s Get With The Guidelines database for five consecutive years. The ART program has resulted in a 20 percent reduction in overall hospital mortality.
As a result, ART has been designated as a Best Practices Model by the Joint Commission and recognized as a Best Patient Safety Initiative by both the National Association of Public Hospitals and the University of California Regents. Most recently, UC San Diego Health System received a Quality Leadership Award from the University Health System Consortium (UHC) based on rapid improvements in overall mortality and patient safety and a top-five ranking in overall quality of care. Perhaps the most telling statistic for ART is that observed mortality at UC San Diego Health System is 38 percent below expected values, leading to UC San Diego’s recognition as one of the safest hospitals in the county, state and country.
In the pre-hospital environment, ART training has resulted in similar outcomes. For patients arresting in the presence of air medical providers, survival-to-ED-admission more than doubled following training. Survival from out-of-hospital cardiac arrest increased 50 percent following ART training in a cohort of San Diego County EMS agencies, and survival among patients arriving to the UC San Diego Emergency Department with ongoing chest compressions rose from zero to more than 9 percent.
The UC San Diego Center for Resuscitation Science teamed with the Society of Hospital Medicine to compete for a federal grant to disseminate the ART program nationwide. The project was termed Hospital Enactment of Advanced Resuscitation Training (HEART) and was designed to accelerate the development of the ART infrastructure and demonstrate feasibility in a group of 15 hospitals across the country. Although very little time was allotted between announcement of the grant program and submission of applications, the HEART program was able to enlist support from an impressive group of organizations that guide inpatient medicine: American College of Cardiology, Society of Hospital Medicine, American College of Emergency Physicians, Society of Critical Care Medicine, American College of Surgeons, American Association of Critical-Care Nurses, Emergency Nurses Association, American Association of Respiratory Care, University HealthSystem Consortium, American Hospital Association, HCA Healthcare, United Healthcare, VA Medical Center, Hospital Alliance for Resuscitation Quality, Sansio, and Summit Performance Group. In addition, the HEART project attracted a team of world leaders in resuscitation science as coinvestigators and advisers. This reflects the broad support the ART program achieved and the universal dissatisfaction with the current standard.