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Establishing a Quality Improvement Program for Pediatric In-hospital Cardiac Arrest
Anya J Freedman1, Erik C Madsen1, Lia Lowrie1
1From the Department of Pediatrics, Division of Critical Care, Saint Louis University, St. Louis, Missouri.
Insights
Improving pediatric in-hospital cardiac arrest (IHCA) outcomes requires coordinated resuscitation team efforts. Quality improvement initiatives, including structured reviews, showed initial success in boosting survival rates after IHCA events.
Area of Science:
- Pediatric critical care medicine
- Quality improvement science
- Healthcare systems engineering
Background:
- Pediatric in-hospital cardiac arrest (IHCA) has a high mortality rate (50-55%).
- Effective cardiopulmonary resuscitation (CPR), timely interventions, and team coordination are crucial for improving IHCA outcomes.
- Current pediatric resuscitation teams often operate in silos, hindering coordinated care.
Purpose of the Study:
- To enhance outcomes following pediatric IHCA by implementing quality improvement processes.
- To improve coordination and integration among traditional, siloed pediatric resuscitation teams.
- To systematically analyze and address factors influencing IHCA survival.
Main Methods:
- Selected outcome measures: return of spontaneous circulation (ROSC), 24-hour survival, and survival to hospital discharge.
- Implemented process outcomes: standardized hot debriefs, revised code documentation, and formal code team reviews.
- Utilized a standardized form for formal code team reviews presented to a central committee.
Main Results:
- Over 36 months, 132 patients experienced 176 IHCA events.
- Survival to hospital discharge increased from 33% to 60% between year 1 and year 2 (P < 0.05), then decreased to 45% in year 3.
- Formal code team reviews achieved 80% adoption rapidly, while hot debriefs and documentation showed limited uptake.
Conclusions:
- Effective CPR team response relies on common, well-executed tasks.
- Committee reorganization, task simplification, technology, and feedback loops are key to optimizing pediatric IHCA response.
- Initial analysis indicates improved survival to hospital discharge following the implemented quality improvement strategies.
Background:
Pediatric In-hospital Cardiac Arrest (IHCA) is a rare event with a 50-55% mortality rate. Techniques of Cardiopulmonary Resuscitation (CPR), medication and electrical therapy timing, team dynamics, simulation and debriefing programs are associated with improved outcomes. This study aimed to improve outcomes after IHCA by describing and implementing quality improvement processes that cross and coordinate among traditional siloed pediatric resuscitation team structures.
Methods:
We chose three outcome measures: (1) return of spontaneous circulation (ROSC), (2) 24-hour survival after IHCA, and (3) survival to hospital discharge. Process outcomes include (1) hot debriefs performed with a standardized form, (2) code documentation using a revised form, and (3) formal code team review presented to a central Emergency Management Committee, using a standardized form.
Results:
One hundred and thirty-two patients experienced 176 events during the 36-month study period. Survival to hospital discharge increased from 33% during year 1 to 60% during year 2 (P < 0.05) but decreased to 45% in year 3. Both hot debrief performance and code documentation process methods did not demonstrate widespread adoption, but formal code team review was documented in 80% of events quite rapidly.
Conclusions:
There are common traits inherent to effective CPR team response. Ensuring optimal performance of these common tasks and techniques in every pediatric IHCA event in our hospital is being addressed by committee reorganization, task simplification, new technology acquisition and enhanced feedback loops. Early outcome analysis shows initial improvement in survival to hospital discharge after pediatric IHCA.
