Part 4: Systems of Care and Continuous Quality Improvement

作者：Steven L. Kronick, Michael Christopher Kurz, Steve Lin, Dana P. Edelson, Robert Allen Berg, John E. Billi, José G. Cabañas, David Christopher Cone, Deborah B. Diercks, James S. Foster, Reylon A. Meeks, Andrew H. Travers, Michelle Welsford · 发表于：Circulation · 年份：2015 · DOI：10.1161/cir.0000000000000258 · 被引用次数：269 · 研究领域：Cardiac Arrest and Resuscitation、Trauma and Emergency Care Studies、Emergency and Acute Care Studies

and device failures can be common to both settings.In both settings, systems must be in place to address expected and unexpected challenges and must be continually monitored and re-examined to address their flaws and failures.The classic resuscitation Chain of Survival concept linked the community to EMS and EMS to hospitals, with hospital care as the destination.1 But patients with a cardiac emergency may enter the system of care at one of many different points (Figure 3).A cardiac arrest can present anywhere, any time-on the street or at home, but also in the hospital's ED, inpatient bed, ICU, operating suite, catheterization suite, or imaging department.The system of care must be able to manage cardiac emergencies wherever they occur.The concept of a system of care has been applied previously in emergency care, including regional systems of care for trauma, stroke, and ST-segment elevation myocardial infarction (STEMI).This Part addresses the idea that IHCA has similarities to, but is very different from, OHCA.It also considers how the elements of a system of care apply to the comprehensive management of cardiac arrest.