# Overcoming Barriers in the Introduction of Early Warning Scores for Prevention of In-Hospital Cardiac Arrests in Austrian Medical Centers

## TL;DR

This study explores barriers to implementing early warning systems in Austrian hospitals to prevent in-hospital cardiac arrests and proposes a practical implementation guide.

## Contribution

The study identifies specific barriers to EWS adoption in Austria and provides a structured tutorial for implementation based on expert interviews and data analysis.

## Key findings

- The incidence of in-hospital cardiac arrests was 0.86 cases per 1000 admissions annually.
- Austrian hospitals show a near absence of multi-parameter early warning systems.
- Strained staffing and lack of survival data are key barriers to EWS adoption.

## Abstract

Introduction: In-hospital cardiac arrest (IHCA) is still associated with high mortality. Introduction of multi-parameter early warning systems (EWS) could reduce the incidence of IHCA. However, data regarding prevention of IHCA remains conflicting. Moreover, an aging population and a shortage of healthcare workers strain Austrian acute care hospitals. Sicker patients and fewer staff could hinder the implementation of multi-parameter EWS in Austria. Therefore, we sought to identify such barriers by assessing local and national data. Furthermore, we investigated the incidence of in-hospital cardiac arrests at Medical University Innsbruck. Methods: In this perspective study, we retrospectively analyzed all patients experiencing an in-hospital cardiac arrest between 2017 and 2024. In the qualitative part, ten experts in in-hospital emergency medicine were interviewed using guided interviews. The main results from the interviews were identified using a structured content analysis according to Mayring. Quantitative and qualitative data were integrated through narrative. Using the Consolidated Framework for Implementation Research, we stratified our data into five domains. Finally, we applied the “eight steps for leading change” to develop a practice guideline. Results: In six years, 1356 patients were treated by an emergency medical team; 1317 emergencies were included, with 365 of them being resuscitated. Overall, 114 survived for 24 h. The incidence rate of in-hospital cardiac arrests was 0.86 cases/1000 admissions per year. The guided interviews demonstrated a nearly complete absence of EWS using multiple parameters in Austria. Strained human resources after the pandemic, the fear of an increased workload and the lack of robust data regarding the benefit of survival were mentioned as main reasons. The best practice tutorial considers the challenges identified and provides guidance for structured implementation in hospitals. Conclusions: Implementing NEWS2 can facilitate detection of critically ill patients despite decreased staffing. Identifying common barriers and facilitators in five domains described and applying this to the “eight steps for leading change” enabled us to provide a tutorial for implementation of an EWS. This could help master future challenges in in-hospital emergency medicine.