(1509) From Good to Gold: Medical Emergency Team Process Improvement

Introduction: In-hospital cardiac arrest events have historically poor survival rates and outcomes (Chan et al, 2022; Peberdy et al, 2008). Successful resuscitation teams are key to improving care quality and long-term outcomes for these patients (Nallamothu et al, 2018). In 2017, a resuscitation program at a 766 bed academic medical center began work on enhancing teamwork and communication, developing mastery of team roles, and creating a quality review process.

Methods: Interdisciplinary leadership reviews every in-house cardiac arrest weekly to identify potential gaps in care or failure to meet American Heart Association Resuscitation standards. These reviews have identified opportunities for improvement and lead to expansion of emergency response services within the organization. In 2019, roles were outlined creating expertise in practice and improving quality measures including documentation and epinephrine administration.

“Hot Debriefs” were added in March 2020 to take place after every medical response. This allows the team to review the call and solutions for performance improvement. A “time out” process was implemented in 2021 to identify roles and complete a standardized handoff between primary responders and the emergency team. In addition in-situ simulations began to allow responders to enhance skills, adapt to growing campus spaces, and clinical concerns.

Results: In 2017, in-house cardiac survival rate was 20%. Medical emergency team members actively engaged in standardizing care and investing in change processes improving survival rates to 35% in 2019. With COVID-19 in 2020 and resulting national drop in survival rates (Chan et al, 2022), these processes maintained a 26% survival rate in 2020 and 2021 for in-house cardiac arrest, higher than comparable institutions, and increased to 27% in 2022. There was a significant drop in 2023 to 23%.

Conclusions: While the medical emergency team provides high quality care and initial efforts improved survival rates, the most recent data shows a continued need to focus on process improvement. Quality reviews show work is needed in regards to earlier discussions of goals of care prior to medical emergency initiation. Future endeavors to improve team response include simulated mock codes, team leader education, and an emergency team back-up system.