We developed a quality assurance (QA/QI) project with the goal to improve and standardize the neurological care of early inpatient post-cardiac arrest care of patients hospitalized at the VA Pittsburgh Healthcare System (VA-PHS). 

Well documented studies show excellent care of patients resuscitated from cardiac arrest improves outcomes.  At VA-PHS, there was no standard approach to care of these patients. In addition, the need for standardization of care and development of guidelines is important given recent recommendations from the Joint Commission regarding care of the post arrest patient. 

We reviewed post-arrest cases over the past 5 years at VA PHS and identified 3 areas of intervention:

1. Design of a standardized post-arrest neurological exam template
2. Design of guidelines for the neurological care of the post-arrest patient
3. Design of an EEG algorithm with guidance on which patients may benefit from transfer to continuous electroencephalography (EEG)-capable centers
4. Design of educational opportunities for healthcare providers regarding the guidelines.

After developing these interventions, we quantified the frequency with which each was used over a 2 year period and identified barriers to their use.

19 post-arrest patients were treated since our intervention.  Of these 15 (88%) had a standardized and detailed neurological exam documented compared to 3 (27%) in the pre-intervention period. The number of patients who received an EEG within 48 hours of arrest increased (12 (85%) post-intervention vs 5 (45%) pre-intervention). Our most significant finding was a reduction in patients transferred to outside hospitals 0% post-intervention vs 7.1% pre-intervention. 

Optimal post-arrest care involves the neurologist. Each hospital needs guidelines specific to their institution and resources. We undertook at QA/QI project to understand what was needed to develop post-arrest guidelines for VA-PGH. This improved appropriate documentation of the neurological exam, acquisition of guideline-concordant neuro diagnostic testing and reduced transfer of patients.