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Resuscitative Services and Post-resuscitation Care – Understanding The Requirements

What are the key concepts organizations need to understand regarding the new Resuscitative Services requirements?

Effective January 1, 2022

Any examples are for illustrative purposes only.

Education and Training in Resuscitation versus Certification Requirements (e.g., BLS, ACLS, PALS, NRP)
The intent of PC.02.01.11, EP 4 is that organizations provide education and training in addition to any certifications.  While certifications provide the necessary foundational knowledge in resuscitation, PC.02.01.11, EP 4 stresses institution-specific education and training to promote staff preparedness that certification courses may not provide (for example, training grounded in local policies, procedures, or protocols, equipment; and the staff's specific roles and expectations during a code event). 

Policies versus Procedures or Protocols
The organization can decide whether it develops a policy(-ies), procedure(s) or protocol(s). The phrase "Policies, procedures, or protocols" in PC.02.01.20 EPs 1 and 2 is meant to convey that the organization may determine which format is used for such documents. The organization can also decide whether the processes for post-cardiac arrest care (e.g., on targeted temperature management (TTM), neuro-prognostication, cardiac arrest in the context of STEMI) will be formalized as a single policy, several policies or procedures, protocols, or a combination of several types of documents.  The intent of the requirements is that interdisciplinary, post-cardiac arrest care is delivered in an organized manner.  Periodic review of processes is expected (the frequency is determined by organizations) to ensure that care and treatment align with current scientific literature. Note: For hospitals that use Joint Commission accreditation for deemed status purposes: Preprinted and electronic standing orders, order sets, and protocols that contain medication orders must meet the requirement MM.04.01.01 EP 15.

Inter-facility Transfers
An inter-facility transfer (see PC.02.01.20 EP 3) is a transfer that occurs between any two healthcare facilities. Examples include hospital to hospital, ambulatory surgical center to hospital, etc.  For the purposes of this requirement, 'inter-facility" does not include transfers between different departments within the same hospital if they are housed in the same building or within the same hospital complex.

In-hospital cardiac arrest (IHCA) versus out of hospital cardiac arrest (OHCA)
The scope of resuscitation requirements includes IHCA and OHCA. For IHCA, there is no particular area of focus in terms of location, e.g., ED, or ICU, general nursing floor, etc.  OHCA management would include post-cardiac arrest care for survivors and, if indicated, inter-hospital transfer.  Organization policy(-ies), procedure(s) or protocol(s) may address IHCA and OHCA together or separately.   Organizations also have the flexibility to decide whether any of the above subcategories should receive priority in performance improvement, based on data, populations served, etc. (see PI.01.01.01, EP 10 and PI.03.01.01 EP 22).

Analysis for Performance Improvement
Under PI.03.01.01 EP 22 organizations are free to choose resuscitation-related metrics or processes to track resuscitation performance. Note 1 provides some examples of analyses that organizations can undertake.  For example, if the organization chooses to focus on the quality of cardiopulmonary resuscitation (CPR), it could consider metrics or measures from the current professional literature, such as:
  • average ventilation rate
  • chest compression depth and rate
  • chest compression fraction
  • time to first shock ≤2 min for VF/pulseless VT first documented rhythm
  • time to IV/IO epinephrine ≤5 min for asystole or pulseless electrical activity
  • peri-shock pauses (pre-shock and post-shock)

Reference: Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., De Caen, A. R., Bhanji, F., ... & Leary, M. (2013). Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation, 128(4), 417-435.

Additional Resources
Joint Commission Perspectives®, July 2021, Volume 41, Issue 7
Requirement, Rationale, Reference R3 Report
Manual: Critical Access Hospital
Chapter: Provision of Care Treatment and Services PC
Last reviewed by Standards Interpretation: September 14, 2022 Represents the most recent date that the FAQ was reviewed (e.g. annual review).
First published date: October 20, 2021 This Standards FAQ was first published on this date.
This page was last updated on September 14, 2022 with update notes of: Review only, FAQ is current Types of changes and an explanation of change type: Editorial changes only: Format changes only. No changes to content. | Review only, FAQ is current: Periodic review completed, no changes to content. | Reflects new or updated requirements: Changes represent new or revised requirements.

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