THE EFFECT OF A CHECKLIST ON VARIABILITY OF CARE AFTER IN HOSPITAL CARDIAC ARREST AT A TERTIARY ACADEMIC MEDICAL CENTER

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: There are approximately 290,000 in hospital cardiac arrests (IHCA) annually in the United States. Recent evidence suggests that post IHCA outcomes may be more related to post return of spontaneous circulation (ROSC) care than intra cardiac arrest resuscitation. The purpose of this study is to assess the effect of a post ROSC checklist on variability care after IHCA with ROSC. METHODS: We performed a retrospective analysis of inpatient adults with an IHCA with ROSC at Harborview Medical Center (HMC) between 1/1/2018-12/31/2019. Included patients had an ICHA on an acute care or intensive care unit (ICU), were over the age of 18, and not placed on extra corporeal membrane oxygenation. IHCA was defined as cardiopulmonary resuscitation delivered by healthcare personnel. Demographics, clinical variables, and process of care metrics were abstracted from the electronic medical record. We then developed a post ROSC checklist utilizing our retrospective data and expert opinion. The checklist was implemented at HMC in January 2020. We conducted a follow up analysis of post-ROSC care since checklist implementation between 1/1/2020-12/31/2020. Pre and post implementation results were compared. RESULTS: 125 IHCA were included in the pre implementation cohort and 47 were included in the post implementation cohort. The mean age of the pre implementation cohort was 55.1 versus 55.9 post implementation. Women comprised 36.8% in the pre implementation cohort and 37.0% in the post implementation cohort. The rate of obtaining an electrocardiogram within one hour of ROSC was 60.8% prior to checklist implementation, and 76.6% after implementation. The rate of obtaining a formal transthoracic echocardiogram within six hours of ROSC was 32.8% prior to checklist implementation, and 34.0% after implementation. The rate of physician documentation occurring within six hours of ROSC was 47.0% prior to checklist implementation, and 85.1% after implementation. The rate of documented notification of family within six hours of ROSC in 67.2% of cases prior to checklist implementation, and 80.8% after implementation. CONCLUSIONS: The introduction of a post ROSC checklist correlated with an increase in obtaining ECGs and completing documentation tasks after IHCA with ROSC at HMC. This study was limited by the small number patients included as well as being a single site study. Confounding circumstances in code blue management related to COVID-19 must be acknowledged. Further research is needed to assess the durability of these findings, and what impact this may have on post IHCA outcomes. CLINICAL IMPLICATIONS: While there will be differences in the management and evaluation of patients who suffer an IHCA, some interventions such as a timely ECG and documentation should be completed with little variance between patients. The use of a checklist decreased the rate of variance, by providing a cognitive aid to guide clinical decisions in a stressful scenario. The use of a post ROSC checklist has the potential to decrease variance in diagnostic and documentation tasks after IHCA. DISCLOSURES: No relevant relationships by David Carlbom, source=Web Response No relevant relationships by Stephen Ferraro, source=Web Response No relevant relationships by Vince Raikhel, source=Web Response No relevant relationships by Vera Schulte, source=Web Response No relevant relationships by James Town, source=Web Response