Changing the Culture to Improve CCF: An Improvement Project.

After identifying chest compression fraction (CCF) as a key area for improvement, our Emergency Medical Services (EMS) agency aimed to improve our baseline monthly median CCF from 81.5% to 90% or more in paramedic-attended medical cardiac arrests by December 2023. The CCF is a process measure that, if improved, has been shown to increase likelihood of survival from cardiac arrest. Working as a hospital EMS agency within a large urban 9-1-1 system, our interventions focused on paramedics once they arrived on scene. This project used repeated Plan-Do-Study-Act (PDSA) cycles with brainstorming sessions, focus groups, and data review to achieve improvement. Our control chart analysis revealed special cause variation and an increase in average CCF to 89.0%. This improvement was achieved through successful implementation of process changes using PDSA cycles. Our most effective and popular intervention was our clinician feedback forms. Additionally, re-unifying patients and their successful resuscitation teams, participating in resuscitation academy events, and pre-charging the defibrillator to minimize CPR pauses collectively resulted in systemic improvement in resuscitation performance. The findings illustrate that targeted education, increased clinician feedback, patient-team reunification, and high-performance resuscitation strategies produce measurable improvement in CCF.