Objective:

We designed and implemented a quality improvement (QI) project using a plan-do-study-act (PDSA) framework to assess and improve utilization of a new systematic approach and up-to-date use of current guidelines for neuroprognostication in adults with cardiac arrest with or without hypothermia treatment.

Background:

Effective neuroprognostication in comatose adult survivors of cardiac arrest is crucial for guiding clinical decisions and aligning care with patient and family expectations. Neurocritical Care Society 2023 Neuroprognostication Guidelines provide a structured approach to deliver evidenced-based care. A QI PDSA framework can be applied to measure baseline consistency of neuroprognostication recommendations and iterative testing of workflow in practice to utilize such recommendations. 

Design/Methods:

Baseline assessment of neuroprognositication data (presence and clarity of summary assessment) was assessed retrospectively in adult patients (³ 18 years) referred to General Neurology Consult service for neuroprognostication after cardiac arrest ± hypothermia  (7/1-9/30/2024). A smartphrase note for cardiac neuroprognostication was developed by authors with key stakeholder input obtained about baseline knowledge, current workflow, feasibility and ease-of-use of using open discussion (grand rounds) and survey assessment. Implementation of new workflow occurred 10/1/2024 with department email reminders. 

Results:

Baseline data (N=18; 8 female; age range 35-82 years) demonstrated varied terminology and structure of notes. Baseline survey data from neurology physicians (N=21) demonstrated 76% (N=16) reported lack of uniformity of current neuroprognostication practice; <50% (N=10) were familiar with new 2023 guidelines; 100% rated important need for standardization. Initiated implementation of new smartphrase on 10/1/2024 with planned continued data assessments (use of smartphrase) and assessment of ease-of use including balancing measure of time to complete note. 

Conclusions:

Baseline neuroprognostication assessment and summaries vary in workflow, language and clarity. Implementation of standardized workflow using a smartphrase that incorporates up-to-date evidenced based neuroprognostication guidelines can provide a mechanism of reliable and systematic care delivery to enhance communication with patients, families, and multidisciplinary teams.