Effect of a Quality Improvement Project on Point-of-Care Ultrasound Utilization During Inpatient Cardiac Arrest

Point-of-care ultrasound (POCUS) use during cardiac arrest (PDCA) is important as it has shown promising results in emergency medicine. Given its increase in use within internal medicine as well, this quality improvement (QI) project was devised to create such a protocol for PDCA within inpatient medicine, determine the current prevalence of PDCA, and survey attitudes regarding its clinical value.

We conducted Plan, Do, Study, Act (PDSA) cycles. Inclusion criteria were admitted adult patients who underwent Advanced Cardiovascular Life Support (ACLS) due to cardiac arrest. All data were collected through retrospective chart review and interviewing. Pre-intervention prevalence of PDCA was determined, and a protocol for PDCA was created and implemented. Data collected included the frequency of PDCA, the degree to which the protocol was followed, and code leaders' opinions on implementation and clinical utility.

From November 2023 to November 2024, 117 code blue activations were reviewed. Eighty-six met inclusion criteria. Code leaders felt PDCA had clinical utility 57% of the time. The reasons PDCA was not utilized included code brevity (25%), delay in delivery of ultrasound to bedside (25%), lack of knowledge of PDCA utility (25%), and lack of proficiency to perform PDCA despite desiring to utilize it (21%). PDCA prevalence was 21%, 10%, 47%, and 23% respectively for each quarter compared to 13% pre-intervention. When combined into 6-month study periods, PDCA was 16% and 35%, respectively.

Code leaders felt that PDCA was useful because it often provided them helpful information and changed management. There is potential for improvement regarding several barriers to PDCA, including difficulty in image acquisition, user knowledge gaps, and physical machine presence, accounting for 95% of reasons PDCA was not utilized.