(1540) Prospective Identification of In-Hospital Cardiac Arrests Across Various Levels of Care

Introduction: Reliable identification of In-Hospital Cardiac Arrests (IHCA) is a cornerstone of resuscitation quality and is a component of Joint Commission regulatory requirements. There is significant variability across levels of care in how IHCAs are identified, documented, and reported. The goal of this study was to prospectively identify IHCAs across various levels of care and to establish core metrics that align with the American Heart Association’s Get with the Guidelines – Resuscitation program (AHA GWTG-R).

Methods: At a single academic tertiary care center, leadership in the emergency department (ED), general wards, and intensive care units (ICU) identified reporting pathways for patients that experience an IHCA. In the ED, an electronic medical record (EMR) report for code narration is used to document IHCA. In the general wards, an activation report for overhead notifications is used. In the ICU, a paper-based code sheet is uploaded to the EMR. Between January 1st, 2023, and June 30th, 2024, trained data abstracters systematically collected the following core metrics from the AHA GWTG-R program: witnessed/monitored vs unwitnessed IHCAs, documentation of initial pulseless rhythm, device confirmation of new advanced airway placement, return of spontaneous circulation, and survival to discharge.

Results: Over the 18-month study period we identified 367 IHCA events across the ED (58 ), general wards (111), and ICUs (198). Across all IHCAs, 337 (91.8%) were witnessed/monitored events. The first pulseless rhythm was captured in 322 (87.7%) of patients. A non-shockable rhythm was documented in 237 (73.6%) of patients and a shockable rhythm was documented in 84 (26.1%) of patients. An advanced airway was placed in 203 (55.3%) patients and 128 (53.2%) had device confirmation of airway placement. Return of spontaneous circulation was obtained in 249 (67.8%) of patients, with 95 (25.9%) surviving to hospital discharge.

Conclusions: Although there is variability in documentation and reporting practices across various levels of care, it is feasible to identify IHCAs and to monitor compliance with core resuscitation quality metrics. These baseline statistics can inform quality improvement projects and satisfy reporting requirements among institutions with heterogeneous approaches to IHCA documentation.