In-hospital cardiac arrest call procedures and delays of the cardiac arrest team: A nationwide study

Aim: Fast arrival of the cardiac arrest team (CAT) is associated with improved survival after in-hospital cardiac arrest however little is known about how we can minimize delays in CAT arrival. This study aimed to investigate differences in the cardiac arrest call procedures in Danish hospitals and identify causes for adverse events delaying the CAT arrival. Methods: This nationwide study surveyed all public somatic hospitals in Denmark with a CAT. We searched for all patient safety incidences related to the cardiac arrest call procedure during a two-year period. Two researchers reviewed all incidents and categorized the cause as either human, technical, or not possible to classify, and whether the incident caused a delay of the CAT arrival. Results: In total, 36 hospitals (78%) responded and all hospitals used a telephone number, a CAT activation button or both for activation of the CAT. We found 131 reports describing an event related to activation of the CAT of which 87 incidents (66%) caused a definite delay in CAT arrival. The most common were human errors (43%) followed by technical errors (32%) and errors not possible to classify (25%). Almost half of the incidents (47%) could have been avoided if the hospitals used a CAT activation button with direct activation of the CAT. Conclusion: There are major differences on the in-hospital cardiac arrest call procedure in Danish hospitals. Human errors are the most frequent cause of safety incidents and may be avoided by simplifying the cardiac arrest call procedure with CAT activation buttons.