• Andrew V Raikhel, David J Carlbom, Stephen Ferraro, Vera Schulte, Nicholas J Johnson, and James A Town.
• Veterans Affairs Hospital Puget Sound Seattle Division, Seattle, Washington, USA.
• J Hosp Med. 2023 Aug 1; 18 (8): 677684677-684.

BackgroundIn-hospital cardiac arrest (IHCA) with the return of spontaneous circulation (ROSC) is a clinical scenario associated with potentially devastating outcomes.ObjectiveInconsistencies in post-ROSC care exist and we sought to find a low cost way to decrease this variability.Designs, Settings, And ParticipantsWe obtained pre and post intervention metrics including percentage of IHCA with a timely electrocardiogram (ECG), arterial blood gas (ABG), physician documentation, and documentation of patient surrogate communication after ROSC.InterventionWe developed and implemented a post-ROSC checklist for IHCA and measured post-ROSC clinical care delivery metrics at our hospital during a 1-year pilot period.Main Outcome And ResultsAfter the introduction of the checklist, 83.7% of IHCA had an ECG within 1 h of ROSC, compared to a baseline of 62.8% (p = 0.01). The rate of physician documentation within 6 h of ROSC was 74.4% after introduction of the checklist, compared to a baseline of 49.5% (p < 0.01). The percentage of IHCA with ROSC that completed all four of the critical post-ROSC tasks after the introduction of the post-ROSC checklist was 51.1% as compared to 19.4% before implementation (p < 0.01).ConclusionsOur study demonstrated improved consistency in completing post-ROSC clinical tasks after the introduction of a post-ROSC checklist to our hospital. This work suggests that the implementation of a checklist can have meaningful impacts on task completion in the post-ROSC setting. Despite this, considerable inconsistencies in post-ROSC care persisted after the intervention indicating the limits of checklists in this setting. Future work is needed to identify interventions that can further improve post-ROSC processes of care.© 2023 Society of Hospital Medicine.

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