Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units
Authors: Dana Mueller, David K. Bailly, Mousumi Banerjee, R.A. Bertrandt, Santiago Borasino, Mario Briceno-Medina, Titus Chan, J. Wesley Diddle, Yuliya Domnina, Katherine Clarke-Myers, Chloe Connelly, Amy Florez, Michael Gaies, Janie Garza, Rod Ghassemzadeh, John Lane, Amy N. McCammond, Mary K. Olive, Laura Ortmann, Parthak Prodhan, Tia Tortoriello Raymond, Jun Sasaki, Carly Scahill, Luke W. Schroeder, Kurt R. Schumacher, David K. Werho, Wenying Zhang, Jeffrey Alten, Megan A. Jones, Benjamin Miller, Katherine Wellman, Alexis Benscoter, David S. Cooper, Sharyl Wooton, Ashley Moellinger, Maria Scalici McAtee, Hayden Zaccagni, Janie Kane, Stephanie Roper, Brittany Bradley, Ashley Dick, Rupal T Bhakta, Ashima Das, Tejas Shah, Grant Burton, Mark Clay, Gabriela Centers, Rudy Wong, Mohammed Absi, Michelle H. Grandberry, Darren Klugman, Christine M. Riley, Justine M. Fortkiewicz, Lisa A. Hom, Kinjal Parikh, Saleem Almasarweh, Anas Abdul Kayoum, Josh Koch, Amanda Richardson, Chasity Wellnitz, Claudia Delgado-Corcoran, Trudy Hardin-Reynolds, Thomas B Do, Amy J. Schalke, Siobhán McMorrow Sciuto, Sean Daley, Joshua S. Wolovits, Priscilla Yu, Julia Gerstmann, Terri Mannan, Jason R. Buckley, Sarah Tabbutt, Titus Chan, Arianna Davis, James Hammel, Alyss Burgert, Bridget Norton, Erica Molitor-Kirsch, Jeremy T Affolter, Laura Miller-Smith, Kelly S. Tieves, Kayla Walz, Colleen Rosenberg, Gabe E. Owens, Katherine Mikesell, Eric Wald, Jade Clark, Kimberly DiMaria, Ryan Wilkes, Page Steadman, Amanda L. Davis, Amanda Smith, Javier J. Lasa, Rebecca Zahn-Schafer, Patrick Maynord, Andrew Harold Smith, Christopher W. Mastropietro, Monica Broo, Erica Vinson, Jane Kluck, Tracy Baust, Tara Graham, Catherine Gretchen, Michael-Alice Moga
Journal: JAMA Network Open (2024)

Importance The Pediatric Cardiac Critical Care Consortium (PC4) cardiac arrest prevention (CAP) quality improvement (QI) project facilitated a decreased in-hospital cardiac arrest (IHCA) incidence rate across multiple hospitals. The sustainability of this outcome has not been determined. Objective To examine the IHCA incidence rate at participating hospitals after the QI project ended and discern which factors best aligned with sustained improvement. Design, Setting, and Participants This observational cohort study compared IHCA data from the CAP era (July 1, 2018, to December 31, 2019) with data from the 2-year follow-up era (March 1, 2020, to February 28, 2022). Data were obtained from pediatric cardiac intensive care units (CICUs) from 17 PC4 CAP–participating hospitals. Intervention The CAP practice bundle was designed to facilitate local practice integration, with the intention to implement, adapt, and continue CAP processes beyond the CAP era. A web-based survey was administered 2 years after the end of the project to estimate CAP-specific QI work. Main Outcomes and Measures Risk-adjusted IHCA incidence rates across all admissions were compared between study eras. The survey generated a novel hospital-specific QI sustainability score, which is generally reflective of the sum of local CAP work performed. Results There were no clinically important differences in demographic and admission characteristics between the 13 082 CAP era admissions and 16 284 follow-up admissions (total mean [SD] age, 5.1 [8.4] years; 56.1% male). Risk-adjusted IHCA incidences were not different between the CAP vs follow-up eras (2.8% vs 2.8%; odds ratio, 1.03; 95% CI, 0.89-1.19), suggesting sustained prevention improvement. There was also no difference between eras in risk-adjusted IHCA incidence within medical, surgical, or high-risk subgroups. A lower hospital QI sustainability score was correlated with higher odds for IHCA in the follow-up vs CAP era (correlation coefficient, −0.58; P = .02). Five hospitals had increases of 1% or greater in risk-adjusted IHCA rates in the follow-up era; these hospitals had significantly lower QI sustainability scores and were less likely to have adopted sustainability elements during the CAP era or report persistent engagement for CAP-related QI processes during follow-up. Conclusions and Relevance In this cohort study of all CICU admissions across 17 hospitals, IHCA prevention was feasible and sustainable; the established reduction in risk-adjusted IHCA rate was maintained for at least 2 years after the end of the CAP project. Both implementation strategies and continued engagement in CAP processes during the follow-up era were associated with sustained improvement.