Failure to Rescue: A Focus on Out-of-ICU Reduction of Cardiac Arrests, A QI Approach

Introduction: Out-of-ICU (OOICU) cardiac arrests are unanticipated, potentially preventable, adverse events that carry significant morbidity and mortality. Prior work at our institution identified several trends in OOICU cardiac arrests. The development of an FTR multidisciplinary team led us to hypothesize that implementing systemic changes to improve early detection of deteriorating patients, reduce barriers to escalation, and enhance response mechanisms would decrease the incidence of OOICU cardiac arrests.


Methods: A FTR multidisciplinary team was established to conduct a biweekly review of all cardiac arrests at a large urban academic medical center from January 2024 to June 2025. Date, location, managing service, and initial rhythm were collected for further analysis. System-wide changes were implemented in June of 2024. The total number of monthly cardiac arrests in and OOICU, as well as the proportion of OOICU events, were compared using Welch's t-tests, given unequal variances.


Results: There were 360 inpatient cardiac arrests, and 151 were OOICU. Between January and May 2024, before the intervention, the mean number of OOICU cardiac arrests was 10.2 per month. Beginning June 2024, interventions were initiated using key drivers and PDSA. Following the intervention, from June 2024 to June 2025, the mean monthly OOICU arrests decreased to 7.2 per month, representing an absolute reduction of 3.0 arrests per month (p = 0.10). The total number of in-hospital cardiac arrests also declined post-intervention, from 22.0 to 18.8 arrests per month (p = 0.37). The proportion of cardiac arrests occurring outside the ICU fell from 47.8% to 37.8% (p = 0.10).


Conclusions: After implementing initiatives derived from an FTR review team, we observed a clinically meaningful reduction in total cardiac arrests, OOICU cardiac arrests, and the proportion of OOICU cardiac arrests. There was an absolute reduction of 3.2 in-hospital cardiac arrests per month and a reduction of 3.0 OOICU cardiac arrests per month, which is clinically significant but not statistically significant. Additionally, there was a 10% decrease in the proportion of OOICU arrests. While these findings support our hypothesis that systemic changes can reduce OOICU arrests, further data collection is needed to establish statistical significance