(1299) A Multifaceted Approach to Improving Cardiac Arrest Outcomes at a Tertiary Hospital in Pakistan

Introduction: In a hospital setting, a code team responds to acute life-threatening situations in a patient's status 24 hours a day, 7 days a week. The effectiveness of a code team's resuscitation could be compromised if any variable, whether it is a medical skill or a non-medical quality, is lacking. Post resuscitation outcome has always been challenging in resource limited set up especially due to system challenges. This study evaluated the impact of multifaceted educational interventions on improving code blue outcomes, specifically focusing on spontaneous return of circulation and survival rates until hospital discharge, along with overall system enhancement.

Methods: This was a prospective cohort study over 3 years period. The hospital-resuscitation committee has undertaken a multifaceted educational intervention using a cyclical action research approach to address challenges within the hospital's Code-Blue process. At first, we identified gaps in the system, code blue processes, knowledge, and skill of team members. We developed a range of strategies that involved educational sessions for doctors, restructuring of the code-blue team, validation of the existing data, and engaging the electronic department in mock code-blue exercises, webinars, and in-situ simulation drills.

Results: Following our educational interventions team members were able to achieve improved MEWS compliance and timely activation of RRT calls. Between 2021 and 2023, the project improved MEWS compliance from 79% to 100%. Furthermore, in 2023, there were 1486 RRT calls compared to 928 in 2022. The compliance rate for the code-blue team's timely arrival at event sites improved to 96% in 2023, from 88% in 2021. Over the years, the return of spontaneous circulation improved from 45.1% in 2021, peaked at 67% in 2022, and was 59.5% in 2023. There was a significant increase in the number of patients surviving to hospital discharge, from 4.83% pre-intervention to 16.28% 2023, a nearly fourfold increase.

Conclusions: Our multifaceted approach was associated with improved system compliance metrics and patient outcomes. To replicate these successes, health care institutions should understand the gap in the system, provide systematic educational interventions, monitor compliance, and cultivate a culture of feedback.