In Situ Cardiac Arrest Simulation

Over 300,000 patients experience in-hospital cardiac arrest in the United States each year, resulting in substantial morbidity, mortality, and loss of disability-adjusted life years. Although survival after in-hospital cardiac arrest has improved over the past 2 decades, outcomes remain poor and many initial survivors of in-hospital cardiac arrest are discharged with substantial disability. Across the United States, risk-standardized survival after in-hospital cardiac arrest varies significantly, reflecting potential for process improvement. Improving processes of care and outcomes after in-hospital cardiac arrest is a priority of national organizations such as the Joint Commission, the American Hospital Association, and other professional bodies. Nevertheless, best approaches to improving in-hospital cardiac arrest care have not been well defined. Performance of regular multidisciplinary in situ cardiac arrest simulations has been identified as a trait common to best performing hospitals with respect to in-hospital cardiac arrest outcomes. However, no clear approach to establishing an in situ cardiac arrest program has been established. In this How I Do It installment, we describe the creation of a robust and sustainable in situ cardiac program including securing sponsorship and assembling a multidisciplinary team, acquiring and maintaining equipment and resources, execution of realistic simulations, and facilitating structured debriefings and continuous quality improvement. Our framework and ready-to-use tools will enable hospitals to implement sustainable in situ in-hospital cardiac arrest simulation programs and drive measurable improvements in care and outcomes.