Discrepancies between Retrospective Review of "Real-Time" Electronic Health Record Documentation and Prospective Observer Documentation of In-Hospital Cardiac Arrest Quality Metrics in an Academic Cardiac Intensive Care Unit

Nicholas A Morris; Cody Couperus; Gregory Jasani; Lauren Day; Christa Stultz; Quincy K Tran

doi:10.3390/jcm12227102

Discrepancies between Retrospective Review of "Real-Time" Electronic Health Record Documentation and Prospective Observer Documentation of In-Hospital Cardiac Arrest Quality Metrics in an Academic Cardiac Intensive Care Unit

J Clin Med. 2023 Nov 15;12(22):7102. doi: 10.3390/jcm12227102.

Authors

Nicholas A Morris^{1

2

3}, Cody Couperus⁴, Gregory Jasani⁴, Lauren Day⁴, Christa Stultz⁵, Quincy K Tran^{2

4}

Affiliations

¹ Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
² Program in Trauma, R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
³ Division of Neurocritical Care and Emergency Neurology, University of Maryland Medical Center, Baltimore, MD 21201, USA.
⁴ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
⁵ Department of Cardiovascular Medicine, University of Maryland Medical Center, Baltimore, MD 21201, USA.

Abstract

Background: Every year, approximately 200,000 patients will experience in-hospital cardiac arrest (IHCA) in the United States. Survival has been shown to be greatest with the prompt initiation of CPR and early interventions, leading to the development of time-based quality measures. It is uncertain how documentation practices affect reports of compliance with time-based quality measures in IHCA.

Methods: A retrospective review of all cases of IHCA that occurred in the Cardiac Intensive Care Unit (CICU) at an academic quaternary hospital was conducted. For each case, a member of the code team (observer) documented performance measures as part of a prospective cardiac arrest quality improvement database. We compared those data to those abstracted in the retrospective review of "real-time" documentation in a Resuscitation Narrator module within electronic health records (EHRs) to investigate for discrepancies.

Results: We identified 52 cases of IHCA, all of which were witnessed events. In total, 47 (90%) cases were reviewed by observers as receiving epinephrine within 5 min, but only 42 (81%) were documented as such in the EHR review (p = 0.04), meaning that the interrater agreement for this metric was low (Kappa = 0.27, 95% CI 0.16-0.36). Four (27%) eligible patients were reported as having defibrillation within 2 min by observers, compared to five (33%) reported by the EHR review (p = 0.90), and with substantial agreement (Kappa = 0.73, 95% CI 0.66-0.79). There was almost perfect agreement (Kappa = 0.82, 95% CI 0.76-0.88) for the initial rhythm of cardiac arrest (25% shockable rhythm by observers vs. 29% for EHR review, p = 0.31).

Conclusion: There was a discrepancy between prospective observers' documentation of meeting quality standards and that of the retrospective review of "real-time" EHR documentation. A further study is required to understand the cause of discrepancy and its consequences.

Keywords: IHCA; cardiac arrest; concordance; documentation.

Grants and funding

This research received no external funding.