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NICU nurse uses CPR skills mastered through RQI to save an infant’s life

It was the start to the day like any other. Most of the neonatal intensive care unit was open, and I had an assignment in the front room taking care of some of our tiniest infants. Maureen was in charge, which usually bring a sense of calm over the unit, as she is so detailed with game plans.

An emergency in Labor and Delivery

It was still early in the morning when the secretary got a call for a crash C-section in OR 3 with heart rate down. I watched as Maureen and Dr. Kim rushed down to Labor and Delivery. After they left, I had this strange sense that something was very bad. Another relief charge, Jenni, and I were engaged in a conversation when the code white bell rang for L & D, OR 3. In that moment we both said at the same time, “are you going, or am I?” And without hesitation I said, “I’ll go.”

I ran down the stairs to the 2nd floor. Each step, I was saying out loud, “don’t fall, don’t fall, don’t fall!” I burst through the door after scanning my badge and the alarm still went off. As I approached the OR doors, my heart was racing. I think, in my mind, I thought I would get in there and they would have resuscitated the infant. That was not the case.

Lifesaving resuscitation for newborn

I had never seen an infant so very pale in my entire career. Compressions had been started and Dr. Kim had already intubated, which was very impressive since I arrived at less than 2 minutes of life. We had no heart rate.

The entire code was like a well-oiled machine. I wish it could have been recorded, as it shows incredible teamwork and communication. Dr. Kim was leading the code, but Maureen was the shining star. One step ahead the entire time. She was so clear and calm.

After she directed me to get the UVC tray ready, get sterile and clean the umbilical cord for Dr. Kim to place lines, I switched in the rotation for compressions. It was in this moment the severity of the situation encompassed my entire being.

Mastery learning kicks in

I remember hearing Dr. Kim say early on that we would only go for 15 minutes. My eyes were glued to that Apgar timer. It felt like all at once time was going too slow and too fast. I was focused on my hands, my depth, my rate of compressions and I realized they had muscle memory. Not from previous codes, in fact it had been 3+ years since I had done compressions in an actual code. No, I had muscle memory from RQI. The practice every 3 months.

The timer continued and we still pressed on. As we approached the 15-minute mark, my heart began to sink that Dr. Kim was going to call it. 14:55, 14:56, 14:57, 14:58, 14:59, 15:00… Then Dr. Kim said, “Keep going!” So, I continued and at 17 minutes and 43 seconds we had a heart rate. We had a heart rate? Yes, we had a heart rate.

We contacted CHOC in Orange for immediate transfer for brain cooling. As we arrived up to our unit, we were met by 3 more nurses who took over to stabilize the infant for transport, giving blood products, bolus’s, and starting drips.

RQI impacts patient’s outcome

After the infant was transferred, we took a quick deep breath and made our way back down to L & D for a debrief. The language was unanimous: it was a really calm, well-communicated code. But what stuck out the most was that Dr. Kim said the only reason that we kept going after the 15 minutes was that the compressions were so effective that he saw a tinge of color return to the infant’s head. I then made a comment, thanks to RQI!

We later found out that the infant responded well to brain cooling and was discharged home a few weeks later. The MRI revealed no brain damage! True miracle. True teamwork.

Prepared to respond thanks to leadership and CPR education

As I was able to witness and participate in such a well-organized, high-intensity situation, I feel as though I saw true leadership in action. I know that I can take what happened in this situation and use it as an example in the future. I improved my leadership by listening and feel I will be able to communicate well in future situations. Hopefully, leading others to where they need to be when it comes to a high stress event.

I am so grateful for the innovation that RQI has brought to our hospital. Even though every 3 months nurses say, “Again, didn’t we just do it?” I truly feel it is assisting with muscle memory and calmness should a nurse enter a code situation. I look forward to new innovations that CHOC at Mission brings and I hope to be a part of them.

Mariah Snyder, BSN, RN, C-ELWB, CLE is a nurse in the NICU at CHOC Children’s at Mission Hospital.


Official 2020 American Heart Association Guidelines for CPR and ECC Releasing October 2020

The American Heart Association recently announced that the official 2020 American Heart Association Guidelines for CPR & Emergency Cardiovascular Care (2020 AHA Guidelines for CPR & ECC) will be published online on Wednesday, October 21, 2020.

We understand that as healthcare providers, you need to be instantaneously prepared and effective in cardiac arrest emergencies as we continue to face the ongoing COVID-19 pandemic.

As you serve on the front lines of saving lives, and in this unprecedented time of physical distancing, the way you deliver CPR and ECC training is evolving. As we work toward the October publication, we are closely working with the American Heart Association evaluating the implications of the new Guidelines on the way we deliver information and training to improve cardiac arrest survival and outcomes – and the impact it has on your hospitals and health systems.

The AHA’s committed to resuscitation science and education

As the global source of the official resuscitation science and education guidelines used by training organizations, the AHA is moving forward with releasing 2020 Guidelines to ensure our hospitals are up-to-date on the very latest resuscitation science and education available.

Integrated directly with American Heart Association science, RQI Partners’ portfolio of digital solutions lead healthcare organizations on a journey to high-quality CPR performance and competence, maximizing lifesaving outcomes. To save more lives, healthcare providers, first responders, and lay rescuers must be competent in delivering high-quality CPR. Additionally, our resuscitation training and education helps patient care teams acquire the skills and knowledge they need to be competent as they work together to improve patient outcomes.

What 2020 AHA Guidelines materials will be released?

The American Heart Association will have the following materials available in English on October 21, with the launch of 2020 Guidelines:

  • All-new AHA Guidelines Website
  • 2020 AHA Guidelines for CPR and ECC Digital Reprint
  • Highlights of the 2020 AHA Guidelines for CPR and ECC (in 17 languages)
  • 2020 AHA Guidelines Science In-Service eLearning Course

We plan to share more information in the coming weeks as we feel it is important for our healthcare providers to remain informed about resuscitation science and education updated because we know that high-quality CPR is the primary component in influencing survival from cardiac arrest.

Our digital solutions provide safe, distanced CPR education through a cost-effective platform, unified seamlessly with American Heart Association science. In a changing world that is still evolving, our digital solutions offer comprehensive skills and cognitive CPR education that is safe, distanced, and tailored to the needs of each individual learner. View our mastery learning here.


American Heart Association Card Extensions Update

Over the last three months, to support you during this challenging time, our parent organizations the American Heart Association and Laerdal Medical have released guidance on additional precautions, options for healthcare providers, interim CPR guidance, just-in-time ventilation modules, and course card extensions.

As the COVID-19 pandemic evolves and providers may have more options available, the American Heart Association released new updates for card extensions as of May 20, 2020. AHA Provider and Instructor cards that expired in March and April, and those expiring at the end of May and June can renew their card for up to 120 days from the recommended renewal date on their card.

Beginning in July, the American Heart Association will resume normal timelines for renewing cards. Those with cards expiring at the end of July should plan to renew their cards by the recommended renewal date on their card (July 2020).

Online, adaptive learning course

To address the significant challenges of providing resuscitation in the age of COVID-19, the American Heart Association launched an online, adaptive learning course on April 9, 2020 to coincide with its scientific statement, “Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19.” This course is a complimentary offering with critical information, clinical guidance, and modified algorithms from the AHA for BLS, ACLS and PALS during the COVID-19 pandemic. You can access the free course on our COVID-19 resources destination, or through the direct link here.

We encourage all healthcare providers to complete this course to enable understanding of how to apply the AHA’s interim guidance for the treatment of cardiac arrest victims with suspected or confirmed COVID-19. This course is another means to deliver on our commitment to support healthcare providers in helping people while protecting their own health and energy, and ensuring they remain competent in lifesaving efforts through effective resuscitation skills.


COVID-19 Ventilator Reskilling Course Now Available

With the high demand for ventilator management in the acute care setting due to COVID-19, healthcare professionals are frequently being called to manage complex patients requiring ventilatory support. In some cases, these healthcare professionals may be unfamiliar with ventilation and may need a refresher course on their skills.

To assist with this potential knowledge gap, the American Heart Association and RQI Partners are offering a self-directed eLearning course to assist healthcare professionals improve knowledge and competence in mechanical ventilation skills.

This adaptive learning course allows participants to identify their skill level at the beginning of the course. As learners progress through the course, they are continuously measured on their level of knowledge based on knowledge checks and customized course content is delivered in areas where information is needed most.

The COVID-19 Ventilation Reskilling eLearning Course includes:

•    Respiratory Physiology
•    Basic Ventilator Functions
•    Ventilator Use and Goals of Care in Respiratory Failure

The list price for this course is $50.00 per learner, and upon successful completion, students receive a certificate of completion. You can purchase the course directly from the American Heart Association’s ShopCPR page.


It takes a system: Thinking holistically about improving OHCA outcomes

When asked to picture the human body, what comes to mind? Most people don’t focus on a single component like a limb or an organ. Instead, they think holistically — looking at the body as an artfully designed system, where every component works in tandem to create life.

Ideally, we’d all have that same holistic “systems” viewpoint when tackling the overlooked epidemic known as out-of-hospital cardiac arrests:

  • An estimated 350,000 OHCAs annually in the U.S. alone
  • Between 70-90% of patients die before reaching a hospital
  • That’s 10x more deaths from opioid overdoses, auto fatalities or gun violence

Yet OHCA garners no headlines. No public outrage. No push for funding to end this unnecessary loss of life.

Why? In theory, because it’s a hard problem to solve.

You’ve likely heard of the “Chain of Survival” — the five links that improve a cardiac arrest victim’s chances of survival and recovery:

  1. Recognition of cardiac arrest and activation of the emergency response system
  2. Early CPR with an emphasis on chest compressions
  3. Rapid defibrillation
  4. Basic and advanced emergency medical services
  5. Advanced life support and post-cardiac arrest care

From a family member or bystander to a telecommunicator, EMT and hospital personnel, each link in the chain of survival can involve someone of widely varying knowledge and training. So, it’s difficult to think holistically when no single entity has accountability for every link in the chain. It’s human nature — we’re focused on playing our role to the best of our abilities rather than looking at the larger picture.

It takes a system to save a patient

Improving OHCA outcomes starts with a shift in thinking. Rather than focusing on individual links in the chain, it’s vital to start thinking in terms of systems: “How do we all work together to optimize our processes from start to finish?”

It’s been proven that survival rates in a community will improve if their EMS and PSAPs work together, have strong leadership, and foster a culture of excellence. In other words, forming a true end-to-end system.

When the Chain of Survival works seamlessly from beginning to end, an out-of-hospital cardiac arrest doesn’t have to be a death sentence. It can mean more years for 350,000 people to live, love and contribute to our world, and the end to a truly unnecessary public health epidemic.

Starting the process of improving OHCA outcomes

To reverse dismal survival rates, every community should be looking at ways to improve how they manage cardiac arrests. But where to begin? It all starts with data — understanding how effective your chain of survival is right now. We recommend first asking these six questions:

  1. What is our community’s Utstein survival percentage?
  2. How frequently do bystanders perform CPR?
  3. What is our time between 911 call and delivery of T-CPR?
  4. What is our department’s median compression fraction for CPR calls?
  5. How do our telecommunicators and EMS personnel train for cardiac arrest?
  6. How do we measure performance on cardiac arrest calls?

Once you’ve established a benchmark for your current performance, you can then identify and prioritize the areas that need improvement and begin the process of developing an effective quality improvement plan.

Bystander CPR rates are highest in communities where public safety answering points (PSAPs), or dispatch centers, provide telephone CPR (T-CPR) instructions.”

— Michael Christopher Kurz, MD, MS-HES, FACEP, FAHA, Chair of American Heart Association T-CPR Taskforce

Is your team operating within High-Performance Standards?

Start by taking the T-CPR Pulse Check. American Heart Association T-CPR Recommendations and Resources provides guidance to construct and maintain a science-based T-CPR program.

 Want to dive deeper into the science behind successful training and quality improvement initiatives?

Read the full AHA scientific statement or download the summary. Have questions on implementing a resuscitation quality initiative in your community? Ask an RQI expert — we are always here to help. Contact us for more information.


911: Is Your Organization Really Prepared for a Cardiac Arrest Emergency?

Over 350,000 individuals will suffer an out-of-hospital cardiac arrest this year — that’s 900+ people each day. Unfortunately, in the U.S. survival rates are dismal; in some communities, as low as 10%.

On out-of-hospital cardiac arrest calls, telecommunicators own the first 600 seconds of the call. They are the first responders and the first to deliver care by guiding callers through life-saving telephone CPR (T-CPR). But it’s up to each agency to ensure that their telecommunicators’ CPR skills remain strong and competent, rather than merely compliant.

To improve patient care, and ultimately survival, the American Heart Association (AHA) recommends addressing six foundational elements essential to improving survival in your community. Is your call center on the same page?

  1. Commit to T-CPR. Without receiving bystander CPR, a cardiac arrest victim has virtually zero chance of survival. To help make bystander CPR happen, telecommunicators must be equipped with high-quality T-CPR skills. It’s up to your agency’s leadership to set the expectation and hold staff accountable to make sure T-CPR is always part of the critical life-saving process.
  1. Provide initial and ongoing training. While cardiac arrest calls account for less than 1% of all calls taken, they are arguably the most critical. According to the AHA, telecommunicators should receive no less than four hours of initial training, as well as a minimum of two hours of continuing education each year relevant to resuscitation and T-CPR.
  1. Conduct continuous QI. Are all cardiac arrest calls reviewed for adherence to protocols? Are you measuring key time intervals? Auditing and measuring performance is key. An effective QI process should have clear, objective data sets with specific individuals assigned to conduct reviews. At a minimum, data should be aggregated annually to identify challenges and inform training needs.
  1. Connect to an EMS agency. A strong EMS system must behave as a team to boost survival rates. Look to your EMS providers for critical feedback on cardiac arrest events. Was there a missed opportunity? Did external factors make an impact? EMS reports can fill in the gaps of your call data to create a more complete picture.
  1. Appoint a designated medical director. To implement high-quality T-CPR, agencies need continuous physician oversight. Medical directors are responsible for establishing guidelines and protocols, and ensuring implementation and liability of your T-CPR program.
  1. Recognize outstanding performance. From the second a call is answered, everything must align perfectly for a patient to survive an out-of-hospital cardiac arrest. That’s why you should honor survivors and telecommunicators, and also recognize the first responders that do everything right to contribute to a patient’s chance of survival.

 A cardiac arrest call is a race against the clock. Every second matters. Empower your telecommunicators to act quickly and correctly, providing high-quality T-CPR instructions and improving the outcome for cardiac arrest victims in your community.

Don’t know where to start? Use RQI’s Pulse Check to see if you’re operating within the latest high-performance standards.


Taking Ownership to Improve an Agency’s CPR Skills

Cardiac arrest survival rates vary widely across the country, but overall, these rates are dangerously low — as low as six percent for out-of-hospital cardiac arrests (OHCA).¹ Clearly, there is room for marked improvement.

The better the CPR, the better a patient’s chances of survival. But how does an agency know exactly how strong its CPR skills are — especially if there’s no mechanism in place to measure and improve?

That question drew Glori Strickler, EMS training coordinator for Matanuska Susitna Emergency Services in Palmer, Alaska, to the RQI Prehospital Healthcare Provider program. She explains, “MatSu is a very diverse agency with varying levels of staff experience. There was ‘tribal knowledge’ in our organization that our providers possessed excellent CPR skills, which was proven not to be the case.”

MatSu’s CPR fraction numbers were in the single digits; team members also lacked the assurance to direct others on critical CPR instruction. There were no interventions in place to boost their performance, and consequently, lives were hanging in the balance.

When it came time to renew MatSu’s traditional two-year BLS, PALS and ALS training — and the expenses associated with those renewals — Strickler was prompted to look for more effective alternatives. “Employing an option we knew was inferior and inadequate to continue the status quo was senseless,” she says. “More importantly, the potential CPR improvement equated to lives saved.”

RQI Prehospital Healthcare Provider provides a high-reliability platform for simulation-based mastery learning, implemented through low-dose, high-frequency quality improvement sessions that measure and verify competence. For Strickler, it represented fresh thinking across several key areas:

  • Learners receive objective, real-time feedback through program’s skills sessions.
  • Fiscal responsibility. RQI began to look very affordable when judged against traditional, yet less effective, options.
  • Staff confidence. According to Strickler, “With an absence of clear roles and responsibilities and communication, even on routine calls, I believed RQI could provide structure and boost confidence in this basic, yet lifesaving, skill.”

MatSu launched its RQI Prehospital Healthcare Provider initiative in January 2017. The program had 100% leadership investment from the start, resulting in full staff participation. And for team members who believed they had been delivering solid CPR already, the results were a huge eye-opener, recalls Strickler.

She points to many benefits of adopting the program — some rather unexpected. “Within a few months, our CPR fraction on actual calls jumped from single digits to the 70th percentile, and now hover around 90% on average. ROSC rates have doubled since implementation. And team members now take ownership and confidently direct others, particularly our fire department colleagues.”

Best of all? “Our survival rates are finally starting to climb.”

With COVID-19 cases starting to appear across Alaska, Strickler especially appreciates how RQI Prehospital Healthcare Provider allows MatSu’s EMS workers and staff to maintain their CPR competence and ability to deliver high-quality CPR. “Our teams can adhere to social distancing, since the program essentially stands alone,” she explains.

Ready to help save more lives?

RQI Prehospital Healthcare Provider is the only program that provides a high-reliability platform for simulation-based mastery learning, through low-dose, high-frequency quality improvement sessions. Find out more.

¹ Berger, S., Survival From Out‐of‐Hospital Cardiac Arrest: Are We Beginning to See Progress?, Sep 2017, Journal of the American Heart Association; 6:e007469.


False Bravado Or Lost Confidence – RQI Bridges The Gap – Lorna Dudzik, DNP, RN, APN, CNS, CEN

Current literature is rich with robust evidence that healthcare providers’ (HCPs) CPR skills decay within weeks to months after the traditional biennial model of BLS training/certification.1 What also decays, or falsely inflates, is not as obvious to measure or quantify, but equally important: HCPs CPR skill confidence, a quiet inner knowledge that one is capable.

Of course I’m capable of performing CPR; I’m always compliant with my two-year BLS certification.” Sound familiar?

There is a gross and precarious misconception regarding HCPs self-perceived confidence to perform high-quality CPR versus their actual skill performance – an insidious phenomenon of reality versus perception.

In a 2017 study of dental students trained in BLS within the two-year certification requirement, researchers discovered that despite the participants reporting a high level of BLS knowledge and skill confidence, their ability to perform BLS did not predict actual competence. As a result, the authors concluded that neither BLS knowledge or perceived self-efficacy is predictive of real competence.2 Certainly, the findings and conclusion of this study can translate to any discipline of HCPs (nurses, physicians, technicians, etc.) trained via the biennial BLS model.

A wide range of individual variances and levels of CPR skill confidence exists, but let’s focus on the polar ends of this spectrum.
On one side are the HCPs who acknowledge their loss of confidence and inadequacy to perform CPR during an in-hospital cardiac arrest (IHCA) event. This category of HCPs runs the other way when a “code blue” is called and consciously, or unconsciously, avoid jumping in to perform life-saving CPR.

On the opposite end are the HCPs who feel a sense of “false bravado”. This category of HCPs erroneously believes that simply because they are compliant within the two-year BLS certification requirement, they will undoubtedly perform high-quality CPR. However, research demonstrates otherwise. Numerous studies show that despite biennial BLS-compliance, HCP CPR skills often fail to meet the key AHA guideline metrics of compression and ventilation (correct compression fraction, recoil, depth, rate, hand placement, and ventilation volume, rate).1,3 Unfortunately, inflated false confidence does not compensate for poorly deflated CPR skill performance – a perilous combination.

Regardless of which side of the confidence spectrum the HCP resides, the effect will not only negatively impact vital CPR skill performance but also result in detrimental outcomes for the IHCA patient.

However, there is a solution. The Resuscitation Quality Improvement® (RQI®) Program.

In a recent comprehensive study at Illinois Valley Community Hospital (IVCH), the first hospital in Illinois to adopt RQI in 2016, researchers surveyed HCPs confidence levels as a result of participation in RQI two-and-a-half years post-implementation. The results were revealing and encouraging. One of the survey items asked HCPS to rate their ability to perform BLS prior to the RQI program via the biennial BLS model, on a confidence level five-point Likert scale of Strongly Agree to Strongly Disagree. The next item asked HCPs to rate their ability to perform BLS on the same Likert scale after participation in the RQI program.

One hundred thirty-two IVCH HCPs were surveyed. Two pre-post-RQI item results revealed increased confidence levels after participation in the RQI program, as follows:



The number of responses for the combined categories of both Strongly agree and Agree demonstrated an improvement of confidence in HCPs’ ability to perform BLS after participating in the RQI program by a total of 19%.

Another survey item asked HCPs if their BLS skill performance will improve using the RQI in the future. The responses were overwhelmingly favorable with a 78% combined total for both Strongly Agree and Agree, as follows:


Skills obtained using the RQI program will improve how I perform BLS in the future.
Frequency Percent Valid Percent Cumulative Percent
Valid Strongly agree 34 25.8 26.0 26.0
Agree 68 51.5 51.9 77.9
Neither agree or disagree 24 18.2 18.3 96.2
Disagree 5 3.8 3.8 100.0
Total 131 99.2 100.0
Missing             System

As early 2016 adopters of RQI, IVCH took a leap of faith and embraced the promise of this novel BLS training platform. The payoff proved to be positive and remarkable. In a recent article regarding analysis results of the RQI study at IVCH, Adam Cates highlighted the significant improvement in HCPs’ CPR compression/ventilation performance during RQI training sessions, an appreciable return on investment, and greater satisfaction with the RQI program compared to the traditional BLS model. Additionally, the HCP perceptual survey results also reflected higher CPR skill confidence due to RQI BLS training. Indeed, an overall win, win, and win.

In summary, the gap between CPR skill confidence and skill performance was bridged at IVCH due to the intentional design and objective of RQI. Consequently, the synergy of two crucial interwoven dynamics, competence and confidence, rose together to reach the ultimate end goal – to improve IHCA survival and outcomes.

For more information of the impact of RQI at IVCH, the study can be fully accessed in the
Joint Commission Journal of Quality and Patient Safety, titled: Implementation of a Low-Dose, High-Frequency Cardiac Resuscitation Quality Improvement Program in a Community Hospital. Authored by Lorna Rozanski Dudzik, DNP, RN, APN; Debra G. Heard, PhD; Russell E. Griffin, MBA, LP, FP-C; Mary Vercellino, MSN, RN, ACNS-BC, CWON; Amanda Hunt, MS, BSN, RN; Maureen Rebholz, EdD, MSN, RN; Adam Cates

This article was written by Lorna Dudzik, is Assistant Professor, College of Nursing and Health Sciences, Lewis University, Romeoville, Illinois, and AHA ACLS/BLS Instructor and Get With The Guidelines® Resuscitation Data Abstractor, Edward Hospital, Naperville, Illinois.

1. American Heart Association. Resuscitation quality improvement annotated bibliography. 2017.

2. Mac Giolla Phadraig C, Ho JD, Guerin S, et al. Neither Basic Life Support knowledge nor self‐efficacy are predictive of skills among dental students. European Journal of Dental Education. 2017;21:187-192.

3. Niles DE, Duval-Arnould J, Skellett S, et al. Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2018;19:421-432.


5 Ways Mastery Learning Gives Learners The Upper Hand

When talking about moving the needle on cardiac arrest survival outcomes by improving the retention of resuscitation skills, we often hear the term “mastery learning” — delivering educational experiences that allow participants to practice until mastery is achieved.

But what makes mastery learning so effective? Simply stated, it’s designed so learners can achieve proficiency in a specific instructional unit before moving on to the next. ¹ The concept was developed by University of Chicago educator Benjamin Bloom, who determined that if aptitude predicts student learning rate, then the extent of learning expected of a student can be set. ²

That’s great in theory, but what about in the real world?

Here are 5 practical reasons why medical educators should support and implement mastery learning programs across medical education:

  1. It provides proficiency targets. Mastery learning promotes deliberate practice and skill acquisition, so learners can focus on proficiency, rather than meeting an arbitrary target number for a particular procedure. ³
  2. It makes learning clearer. Mastery learning provides the advantage of time to elaborate on the principles behind a task and define the end points of that task. 4
  3. It promotes a positive attitude. When learners can approach a challenge at their own pace, it removes unwarranted pressure and builds confidence for a more positive experience.
  4. It provides learners with multiple opportunities to master content. Since students are not bound to a strict learning structure, they can take the time needed to learn — retaking exams, attending open lab sessions or focusing their efforts on concepts that are more difficult to grasp.
  5. It gives students greater control. When you give learners unlimited opportunities to master the content, they can progress at a rate based on their own understanding. This gives them direct influence over their own learning outcomes.5

Taking a more powerful approach to learning

In modern medical and simulation training, the advantages of mastery learning are clear. That’s why it’s one of the pillars of the AHA’s “Resuscitation Education Science: Educational Strategies to Improve Outcomes from Cardiac Arrest.” Read the full scientific statement or download the summary.

Have questions on implementing a resuscitation quality initiative that includes mastery learning in your community? Ask an RQI expert — we’re always here to help.

1 Block JH, Burns RB. Mastery learning. Rev Res Educ. 1976;4:3–49.

2 Bloom, B.S. (1982). All our children learning. A primer for parents, teachers, and other educators. New York, NY: McGraw-Hill.

3 Siddaiah-Subramanya M, Smith S, Lonie J. Mastery learning: how is it helpful? An analytical review. Adv Med Educ Pract. 2017 Apr 5;8:269-275.

4 Siddaiah-Subramanya M, Smith S, Lonie J. Mastery learning: how is it helpful? An analytical review. Adv Med Educ Pract. 2017 Apr 5;8:269-275.

5 Dionne Sutton Roberts, PhD, FNP-C; Racquel R. Ingram, PhD, RN; Silvia A. Flack, EdD, RN; Robyn Jones Hayes. Implementation of Mastery Learning in Nursing Education. Journal of Nursing Education. 2013; 52 (4):234-237.


Staying Committed to Quality T-CPR During a Crisis

Cardiac arrests don’t stop during a pandemic. And we all know the statistic –— immediate bystander CPR can double or even triple a cardiac arrest victim’s chance of survival, and T-CPR could double the number of victims who get CPR from bystanders.

Telecommunicators need to be ready. But skills decay, hesitation and lack of confidence all contribute to delays in recognition of cardiac arrest and increased hands-to-chest time.

“COVID-19 has definitely changed things, for example the safety questions we now have to ask for the first responders,” says Antonella “Toni” Volpe, Support Service Captain for 911 Fire/EMS Communications in Charles County, Maryland. ‘Have you been in contact with anyone who has a confirmed case of COVID-19? Does the patient have a fever 100.4 or greater, Hot to the touch in room temperature? Chills? Trouble breathing or shortness of breath? Persistent coughing, sneezing or wheezing?’ The challenge is asking more questions while not delaying bystanders’ hands to chest.”

Fulfilling the commitment to saving more lives

T-CPR skills improvement can’t come to a halt during a crisis. But traditional classroom EMD training and continuing education are more complicated than usual in the age of COVID-19:

  • Classroom training may not allow for social distancing, creating exposure for staff
  • Training may be canceled due to building closures and stay-at-home orders
  • Required certifications and credentials may lapse due to lack of training

Volpe’s Charles County agency, which began implementing the RQI-Telecommunicator (RQI-T) quality improvement program in August 2019, has been able to continue its efforts despite the current COVID-19 crisis.

RQI-T meets the challenge of providing training and continuous resuscitation quality improvement, reducing the preventable harm caused by poor quality CPR, while addressing the significant challenges presented by the pandemic. Rather than the typical instructor-led group training, it leverages online, simulation-based learning in small doses, along with facilitated coaching and debriefing sessions.

Columbia County, Oregon’s 911 Communications District has had a similar experience with RQI-T, according to Operations Manager Lara Marzilli. “We had other training scheduled that was supposed to be classroom training, so we had to cancel. But we can continue with RQI-T because it can be done individually.”

For PSAPs concerned about the difficulty of implementing a quality improvement effort during the pandemic, Marzilli has some practical advice. “The RQI-T program hasn’t been disruptive to operations at all. If anything, I think our staff appreciates the ‘normalcy’ of continuing the program and seeing the trainer’s familiar face, hearing his voice. The routine of it is appreciated right now.”

Marzilli and Volpe note the positive feedback from their staff members taking part in the program. Says Volpe, “We’ve seen some great changes, some really positive changes. People are getting hands to chest more quickly. I’ve heard staff on the floor saying, ‘If they don’t say yes, you must compress.’ These observations are being made more quickly. And more lives have been saved in the process.”

Adds Marzilli, “In the beginning, people were nervous about doing the RQI-T scenarios. Now, they really appreciate the feedback — both the information itself and the way it’s delivered.”

RQI-T: Simplifying CPR quality improvement initiatives

As both agencies adjust to life during a pandemic, Volpe and Marzilli reflect on the positives RQI-T has made possible. “RQI-T has been a very good experience for us. Staff is appreciative of it,” according to Marzilli. “When I’m at a conference, staff from other centers will ask, ‘Hey, are you using RQI-T?’ and I tell them it’s been really, really positive for us. It’s something we’ll be continuing long-term.”

Adds Volpe, “The RQI-T program is something we really needed — and I’m glad we could continue without interruption during the pandemic.” She continues, “We’ve gotten into a comfortable rhythm. Even with changing state protocols, RQI has been able to incorporate updates very quickly so everything stays current.”

For more information on implementing a T-CPR quality improvement program, visit T-CPR.


Resolving COVID-19 skills preparation needs: an example of leadership

John Mouw, of Baptist Health South Florida, oversees an organization of 12 hospitals and 50+ Ambulatory, UCC, Free Standing ER, and other healthcare facilities in South Florida. He shared how has lead his team to transition to a new resuscitation training environment using HeartCode .

“These are fluid times that require transitional leadership in all things and this pandemic has emphasized that fact in no uncertain terms for healthcare.”

“The interesting thing about the redirection of resources is that it demanded  the need for an impromptu resuscitation certification/retraining solution. Not to mention the training/certification needs for onboarding newly hired staff looking for BLS, ACLS, PALS, or NRP classes so they would be eligible for hire. At this point I am sure some are saying, ‘just get the nurses in there, we will worry about certifications later.’ To me, this is trading off one form of emergently needed skills for another where missing either puts a patient at risk.”

Mouw quickly initiated a few innovative actions to address his organization’s needs to safely stay current and competent during the pandemic. At Baptist, he is using a combination of self-directed learning, virtual assessments and a very limited scope of in-person sessions only when needed for those who have never been trained in BLS.

The majority will be assigned HeartCode Complete for online cognitive learning and autonomous BLS skills practice and assessment on the skills station. The ACLS/PALS mega codes will be one-on-one with an instructor in an isolated room separated by a one-way mirror to limit exposure. This training occurs at the Baptist Health South Florida Clinical Learning Center (CLC) Simulation Suite.

As our way of life is changing due to ongoing developments in the COVID-19 pandemic, these self-directed digital learning programs give providers and administrators the ability to stay safe, competent and prepared.

Along with our parent organizations – the American Heart Association, Laerdal Medical – we are committed to delivering COVID-19 resources to ensure providers keep their focus where it needs to be in this moment: helping people and protecting their own health and energy, while ensuring they remain competent for helping save lives through effective resuscitation skills. Please visit our COVID-19 resources destination.

To spread our gratitude and show our support to healthcare providers, we’ve created posters you may download, print and display at your organization. You can access these posters on the COVID-19 resources page. We’re committed to helping your teams stay safe, competent and prepared.


A message from our Vice President, Strategic Research and Innovation, Russell Griffin

To address the significant challenges of providing resuscitation in the age of COVID-19, the American Heart Association has launched a new online, adaptive learning course to coincide with the recently released Scientific Statement, “Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19.”

This course is a complimentary offering with critical information, clinical guidance, and modified algorithms from the AHA for BLS, ACLS and PALS during the COVID-19 pandemic. We encourage all healthcare providers to complete this course to enable understanding of how to apply the AHA’s interim guidance for the treatment of cardiac arrest victims with suspected or confirmed COVID-19. It can be accessed through a range of electronic devices and platforms including PCs and mobile devices.

This course is another means to deliver on our commitment to support healthcare providers in helping people while protecting their own health and energy, and ensuring they remain competent in lifesaving efforts through effective resuscitation skills.

New CPR COVID-19 Reference

Another new resource, “5 Things Every Healthcare Provider Should Know About CPR for COVID-19 Patients” is available as a downloadable quick reference to reinforce the key points of the Scientific Statement for your provider staff.

In the days and months ahead, we stand ready to assist you to stay safe, healthy and prepared.


Russell Griffin MBA, LP
Strategic Research and Innovation
RQI Partners, LLC


COVID-19 guidance and online course update from our COO, Brian Eigel

As the COVID-19 crisis continues to unfold, we’re listening and learning, and committed to helping all within our healthcare community on the front lines helping save lives. I’m contacting you today to share a new Scientific Statement, an online learning module and a library of resources to address some of your urgent concerns.

Earlier today, to address the challenges of providing resuscitation in the setting of the COVID-19 global pandemic and to balance the immediate needs of the victims with the provider’s safety, the American Heart Association released a Scientific Statement: Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19.

A new online adaptive learning course, developed to support and coincide with the release of the Scientific Statement, will enable healthcare providers to understand how to apply interim guidance to treat cardiac arrest victims with suspected or confirmed COVID-19. This complementary eLearning course: Interim Guidance for Resuscitation of Patients With Suspected or Confirmed COVID-19 can be viewed on desktop, laptop, mobile device or through a learning management system, and is available for download.

Saving Lives Safely
Along with our parent organizations – the American Heart Association, Laerdal Medical – and our partners at the Resuscitation Academy Foundation – we are committed to delivering COVID-19 resources to ensure providers keep their focus where it needs to be in this moment: helping people and protecting their own health and energy, while ensuring they remain competent for helping save lives through effective resuscitation skills. You can access these resources and new guidance on our COVID-19 Support page. Please use them freely with all of your colleagues.

We’re thankful for the valiant efforts you and your fellow healthcare professionals continue to provide and are privileged to have this opportunity to be of service.


Brian Eigel, Ph.D.
Chief Operating Officer
RQI Partners, LLC


CPR in the age of social distancing

In today’s climate of social distancing to control the spread of coronavirus (COVID-19), self-directed education and training through Resuscitation Quality Improvement (RQI) and HeartCode Complete support continued CPR competence and preserve current safety protocols. Designed for individual learning, the programs allow providers to remain at the point of care and avoid the closeness of a classroom setting.

“Our technology platforms, simulation stations and solution delivery teams are fully available to health care systems during this critical time,” said Brian Eigel, Ph.D., chief operating officer of RQI Partners, a partnership between the American Heart Association and Laerdal Medical.

RQI Partners advises medical teams to follow the infection control protocols of their individual facilities and provides guidance from Laerdal Medical in “Basic Cleaning and Maintenance for RQI and HeartCode Complete Equipment and Stations.”

Laerdal Medical has a series of webinars available, “Helping Prepare Your Organization for Coronavirus (COVID-19),” for hospital health care teams to test and improve systems for infection control, personal protective equipment, and management of exposure to high-risk communicable respiratory illness.

RQI Partners is thankful to all healthcare providers for their unwavering commitment during this uncertain time as we all hope to help the health and well-being of people everywhere.


New Podcast and Resources Now Live at the American Heart Association CPR COVID-19 Webpage

The American Heart Association has released a new podcast, “Insights from King County/Seattle EMS Coronavirus Response,” featuring AHA resuscitation science experts and volunteers Tom Rea, MD, and Michael Sayre, MD.

This podcast reviews lessons learned by EMS and other healthcare providers in King County as they’ve responded to the COVID-19 pandemic. Dr. Sayre and Dr. Rea also discuss steps EMS and other healthcare providers can take now to prepare for increasing numbers of patients with COVID-19.

Please view the new podcast and additional resources on COVID-19 and CPR training including healthcare provider interim guidance, community FAQs, and more at the AHA’s new COVID-19 CPR & Resuscitation Resources webpage. Stay tuned to this page in the coming days for additional “Insights from the Front Lines.”


How a Community Hospital Improved Their CPR Performance and Reduced Training Costs by Nearly 50% Annually

What motivates you to do your best at your job each day?

I help hospitals save more lives.

As an Impact Manager for RQI Partners, I take great pride in my goal to ensure the success of hospitals that have adopted the RQI Program. The healthcare organizations I support have chosen to improve their resuscitation education program, allowing them to save more lives, reduce training costs and increase staff satisfaction – all this while creating a culture of resuscitation excellence and establishing a new standard of care within their organization.

It’s especially rewarding when these benefits are documented and quantified to share with others to drive change and life-saving potential. I was asked to participate in evaluating the impact of RQI at Illinois Valley Community Hospital (IVCH) in Peru, Illinois. IVCH is a 49-bed rural acute care facility south of Chicago that implemented RQI in 2016 and underwent a program implementation study to determine the impact of RQI on their resuscitation program. The results were recently published in The Joint Commission Journal on Quality and Patient Safety by Lorna Rozanski Dudzik, DNP, RN, APN; Debra G. Heard, PhD; Russell E. Griffin, MBA, LP, FP-C; Mary Vercellino, MSN, RN, ACNS-BC, CWON; Amanda Hunt, MS, BSN, RN; Maureen Rebholz, EdD, MSN, RN; and myself.

Community hospital experienced several benefits after implementing RQI

The study examined several areas of IVCH’s experience adopting the RQI Program, including staff psychomotor performance in CPR training, staff feedback on RQI, and a cost comparison of the RQI program versus traditional BLS training expenses. Results were overwhelmingly positive:

  • CPR performance improved significantly for both compressions and ventilations
  • Staff reported high satisfaction with the RQI program
  • RQI cost 47.4% less than traditional instructor-led BLS training


As the Impact Manager for IVCH, the study results were not a surprise to me. I have spent a lot of time at IVCH, from their initial evaluation of RQI to the present, working closely with staff, sharing best practices, and optimizing their utilization of the RQI program.

Study revealed opportunities for improvement

An area that has always presented a challenge with RQI data is the lack of baseline measurements to compare to the quarterly skills assessments in RQI that are administered with feedback. I am excited that future research will have baseline measurement given that RQI 2020 has incorporated initial and follow-up baseline measurements as part of the curriculum. This will help alleviate the primary limitation to this study.

The other limitation of note is compliance. To date IVCH has a compliance rate of 95.7% in RQI, meaning that percentage of assigned activities have been completed. Policy modification and staff satisfaction and the impact of RQI on hospital culture are all factors that have a positive impact on compliance over time.

Lastly, rural institutions, such as IVCH, often don’t have the volume of cases to effectively track IHCA outcomes. Partnering RQI with programs like the American Heart Association’s Get With The Guidelines Resuscitation will allow them to more effectively benchmark with larger facilities with higher case volumes. Additionally, RQI provides IVCH with a means to monitor performance and ensure high quality CPR is delivered. The ability to provide relevant data on CPR performance represents one of the most rewarding aspects of my job.

Adam Cates is an Impact Manager at RQI Partners.


Educational Efficiency, the Emerging Factor in Utstein’s Formula For Survival

The Utstein Formula for Survival depicts the three components essential to improving survival from sudden cardiac arrest – medical science, educational efficiency, and local implementation. While equally weighted from a mathematical perspective, only recently has education stepped into the spotlight with its fellow factors to exact its importance in the formula for survival. This paradigm shift is important. In an area where education has traditionally been a second consideration, it is now being given the attention it deserves. This newfound reputation is heavily attributed to the 2018 publication of the American Heart Association’s scientific statement: Educational Strategies to Improve Outcomes from Cardiac Arrest.

Read More >


Powerful, Adaptable Data Reporting – Now Available With RQI

The American Heart Association’s Get With The Guidelines® (GWTG) program is focused on quality improvement for hospitals. One of the GWTG tools is focused on in-hospital resuscitation. How’s that going at your hospital?

We know you are committed to safe, effective resuscitations, but do you know your survival outcomes? How is your hospital compared to others? Let’s look at a Get With The Guidelines-Resuscitation (GWTG-R) data set from the Midwest. Read More >


Six Questions Every Community Should Ask About Cardiac Arrest

Each year, approximately 350,000 people experience out of hospital cardiac arrest in the United States. That equals 960 instances daily. Most of these events occur at home. Unacceptably, only about one in 10 patients survive to hospital discharge.

The path to improving cardiac arrest outcomes is best described using the mantra, “Measure improve, measure improve.” However, cardiac arrest is a complex incident containing a great many potentially measurable metrics. Where should one start to measure? Read More >


Happy Nurses Week!

As a nursing professional, I have been caring for patients for more than 30 years. There have been countless times when I have shared words of support, encouragement and comfort, held a hand or just sat quietly next to a patient’s bed.

And I have been in situations where I had to deliver lifesaving care to a patient. My actions and interactions over this 30+-year span may have been small or significant, but they made a difference in the lives of my patients.

In April 2017, I became a patient. And yes, nurses did what they do every day — provided the best and highest quality of care to bring me through a frightening event. It is because of them I am here today to share my story.

In recognition of Nurses Week 2019, I celebrate this great profession, my life’s calling, and salute the many men and women across this country who join me each and every day in making a difference in patients’ lives.

Michael Lovelace, RN - UAB Hospital
Michael Lovelace, RN – UAB Hospital

Leaders In Resuscitation Excellence, Your Partners In Innovation

When you have a responsibility for resuscitation quality and patient care, it’s important to understand the full impact that a resuscitation program has on the safety and outcomes of your patients. American Heart Association programs are the Gold Standard for quality and efficacy you can rely on to protect your staff and your patients, and ensure your mission to provide the highest quality of care.

Widely recognized as the leader in resuscitation science and education, the AHA sets the standard for resuscitation quality and cardiac care in the United States. You may not realize this, but the AHA is also the only U.S. organization that is a part of ILCOR (International Liaison Committee on Resuscitation) and the source for CPR and Emergency Cardiovascular Care Guidelines in North America.

Read More >


Happy Holidays from RQI Partners

As 2018 rapidly draws to a close, RQI Partners has taken the opportunity to look back at what an eventful and transformative year this has been.

This year,  the American Heart Association and Laerdal Medical joined together to host the inaugural RQI 2020 Keynote and Healthcare Networking Conference  in Dallas, Texas. Two mission-driven organizations united to revolutionize the standard of care in resuscitation practice and accelerate our mission to save 50,000 additional lives each year. Additionally, the organizations announced the formation of RQI Partners …

This year also saw RQI Partners develop new and impactful partnerships with other trailblazing companies – Relias and HealthStream – that are equally dedicated to this lifesaving mission .

With so much to be thankful for as we approach  the Christmas holiday, we are also earnestly looking forward. RQI Partners is eager to continue its mission, extend its reach and save more lives in 2019.

Happy Holidays and a Happy New Year from all of us at RQI Partners to you, your friends and loved ones!

Happy Holidays – Warm wishes for peace and joy in the holiday season and throughout the new year.



Partners in Innovation

The American Heart Association and Laerdal have changed the paradigm for resuscitation practices – and it’s working successfully at leading health care organizations. Learn how these organizations have pioneered the Resuscitation Quality Improvement program as trailblazers for a new standard of care.

This new standard emphasizes mastery learning with low-dose, high frequency quality improvement sessions that measure and verify competence in high-quality CPR. By practicing CPR more often in shorter sessions, knowledge and skills stay sharp, decay is prevented and more lives are saved. Hospital staff are verified as competent to deliver high-quality CPR on any given day, to every patient. The paradigm has shifted from course completion to every day competence for your providers. RQI offers a scalable, high reliability system for the new standard that builds efficiencies, lowers costs and improves patient outcomes and lowers costs.