Influence of Administrative Intervention on the Availability, Utilization, and Competency for the Use of Defibrillators in Primary Hospitals
Introduction
Sudden cardiac death (SCD) remains a critical global public health challenge, with timely cardiopulmonary resuscitation (CPR) and defibrillation serving as pivotal interventions to improve patient outcomes. Despite the proven efficacy of defibrillators in saving lives, their availability and utilization in China, particularly in primary healthcare settings, have been suboptimal. Primary hospitals, which form the backbone of community healthcare in China, often face challenges in infrastructure, funding, and training. This study evaluated the impact of administrative intervention—a coordinated effort involving policy directives, resource allocation, and training programs—on the availability, utilization, and staff competency related to defibrillators in primary hospitals across Suzhou City, Jiangsu Province, China.
Methods
The study employed a cross-sectional design comparing data collected before and after an administrative intervention. All primary hospitals (public and private) registered with the local health bureau in Suzhou’s four districts (Industrial Park, Hi-tech Zone, Xiangcheng, and Wuzhong) and five county-level cities (Changshu, Kunshan, Taicang, Zhangjiagang, and Wujiang) were included. Initial surveys were conducted from November 27 to 29, 2013, to assess baseline status. Key metrics included defibrillator availability, operational status, maintenance records, usage frequency, and staff competency in operating defibrillators.
The administrative intervention was implemented following the 2013 survey. Recommendations from an expert panel prompted the Suzhou Municipal Health Bureau to issue guidelines mandating improvements in defibrillator accessibility, maintenance protocols, and CPR training. Interventions included financial support for purchasing devices, standardized maintenance protocols, and structured training programs for healthcare staff. A follow-up survey was conducted from November 26 to 28, 2014, to evaluate the impact of these measures.
Staff competency was assessed through practical evaluations of attending physicians and head nurses in emergency departments. Two independent experts scored their performance in defibrillator operation, with the average score used for analysis. Statistical analyses compared pre- and post-intervention outcomes using chi-squared or Fisher’s exact tests for categorical variables and Mann-Whitney U tests for non-parametric continuous data.
Results
Defibrillator Availability
In 2013, 137 primary hospitals (94 public, 43 private) were surveyed. Post-intervention in 2014, the number remained stable at 137 hospitals (95 public, 42 private). The proportion of hospitals equipped with defibrillators increased marginally from 60% (82 hospitals) in 2013 to 64% (88 hospitals) in 2014, though this difference was not statistically significant (P = 0.455). The total number of defibrillators rose from 98 to 113, with most devices located in emergency departments (71% in 2013 vs. 76% in 2014). Operating rooms and other departments accounted for minimal defibrillator placements (Table 1).
Operational Status and Maintenance
Significant improvements were observed in device maintenance and functionality. The proportion of “well-managed” defibrillators—defined as those in-service with complete maintenance records—increased from 49% (48 devices) in 2013 to 69% (78 devices) in 2014 (P = 0.003). In-service rates (devices in working condition) also improved from 58% (57 devices) to 70% (79 devices), though this increase did not reach statistical significance (P = 0.075).
Utilization Frequency
Despite improved availability and maintenance, defibrillator usage declined post-intervention. The average annual use per device decreased from 0.73 times in 2013 to 0.45 times in 2014. This paradoxical trend may reflect increased device distribution without a corresponding rise in clinical demand or awareness.
Staff Competency
Competency assessments revealed mixed outcomes. In private hospitals, post-intervention scores for both doctors and nurses showed statistically significant improvements. Median scores for doctors increased from 84 (interquartile range [IQR]: 79–89) to 89 (IQR: 84–93; P = 0.037), while nurses’ scores rose from 75 (IQR: 63–85) to 90 (IQR: 84–93; P = 0.007). In contrast, public hospitals showed no significant changes in competency scores for doctors (93 vs. 90; P = 0.103) or nurses (91 vs. 89; P = 0.201).
Discussion
Impact of Administrative Intervention
The study demonstrates that centralized administrative measures can enhance defibrillator readiness in primary hospitals. The significant increase in well-managed devices highlights the effectiveness of enforced maintenance protocols and funding allocation. However, the modest rise in availability (60% to 64%) underscores persistent gaps in resource distribution. Regional disparities in healthcare infrastructure and funding may explain why some hospitals remained unequipped despite intervention.
The decline in device utilization raises questions about clinical demand versus supply. While increased availability theoretically improves emergency response, low usage rates suggest under-recognition of SCD cases, reluctance to use devices, or inadequate integration of defibrillators into routine emergency protocols. Further studies are needed to explore barriers to utilization.
Staff Training and Competency
The divergent outcomes between public and private hospitals in staff competency warrant attention. Private hospitals, often smaller and more agile, may have implemented training programs more effectively. Public hospitals, constrained by bureaucratic processes or larger staff sizes, might require longer intervention periods to achieve similar gains. The marked improvement among nurses in private settings emphasizes the role of targeted training in enhancing frontline emergency response.
Limitations and Future Directions
This study focused on a single urban-rural region in China, limiting generalizability. The short one-year intervention period may not capture long-term sustainability of improvements. Additionally, the study did not explore patient outcomes or survival rates post-defibrillation, which are critical for assessing real-world impact. Future research should expand to diverse regions, track longitudinal outcomes, and integrate patient-level data to evaluate clinical efficacy.
Conclusion
Administrative intervention can improve defibrillator management and staff competency in primary hospitals, though challenges persist in universal device availability and utilization. Coordinated efforts involving sustained funding, maintenance protocols, and periodic training are essential to optimize emergency cardiac care. Addressing systemic barriers and fostering a culture of proactive device use will be crucial for reducing SCD mortality in China’s primary healthcare system.
doi.org/10.1097/CM9.0000000000000399
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