Resuscitation Programs ART/BART
Advanced Resuscitation Training
Overview of Program
The Advanced Resuscitation Training (ART) program represents a novel approach to resuscitation oversight and education that shifts control of the curriculum content, format, treatment guidelines, and specific initiatives or “special projects” to the individual institution, with guidance and resources provided by the UC San Diego Center for Resuscitation Science.
Decisions regarding algorithms, training, and special projects are driven by CQI data and emerging science, creating a constantly evolving program. Key principles include early recognition and prevention of deterioration, simple arrest and peri-arrest protocols, integration of various aspects of resuscitation (adult/pediatrics, rapid response/critical care/arrest, procedures/decision making), and teamwork training using simulation. Training is adaptive in that providers assume their usual roles during a resuscitative event using the actual equipment deployed in their institution.
Over the past five years, we have observed a tremendous improvement in outcomes as a direct result of the ART program. Life support training has been elevated from a regulatory requirement to the primary vehicle for ensuring patient safety and optimizing cardiopulmonary arrest outcomes.
Since the initiation of the ART program, the following outcomes have been achieved:
- Cardiopulmonary arrest survival has doubled and is currently more than twice the national average (defined by the American Heart Association Get With The Guidelines).
- Neurologically intact arrest survival has tripled in non-ICU patients.
- The incidence of non-ICU arrests has decreased by more than 60%.
- The improved survival and decreased arrest incidence in non-ICU patients (whose deaths would have been unexpected and reflect systemic failures) have dramatically enhanced patient safety and lowered medicolegal risk. Annual payouts for legal claims have decreased by 95%.
- Observed mortality is 38% less than predicted based on patient acuity (lowest in county and state and among the top nationally).
- Overall hospital mortality has dropped almost 25% in the last five years, the vast majority of which is directly attributable to the ART program.
- Expenditures for life support training have decreased by over 35%.
The ART program has been designated a Best Practices Model by the Joint Commission and received recognition from the National Association of Public Hospitals and University Health System Consortium. The American Hospitalist Association commissioned an independent evaluation of the program and concluded that ART is clearly the optimal approach to managing resuscitation but recognized the challenge of widespread implementation. To this end, we have teamed with Society of Hospital Medicine to create the Hospital Enactment of Advanced Resuscitation Training (HEART) project, which combines ART’s innovative approach and potential to improve outcomes with Society of Hospital Medicine’s expertise in hospital implementation. The HEART project has assembled a world-class team of advisors and enlisted letters of support from most key professional associations involved in inpatient medicine.