Optimising the emergency-readiness of public access defibrillators across Wales using quality improvement methodology

Early bystander cardiopulmonary resuscitation and use of automated external defibrillators (AEDs) have been shown to significantly improve survival from out-of-hospital cardiac arrest (OHCA). Public access to AEDs, also known as public access defibrillators (PADs), is hence a critical component for successful emergency bystander intervention.Wales currently has over 8000 PADs registered on a UK-wide defibrillator network-'The Circuit' supported by the British Heart Foundation. This enables emergency services to direct people to the nearest emergency-ready PAD when an OHCA occurs. However, not all PADs are on The Circuit as registration is not mandated, and maintaining PAD fleets in emergency-ready status represents a substantial challenge. Limited research exists regarding the veracity of operational status of PADs in real-world settings, or initiatives which increase numbers of available emergency-ready PADs.This national quality improvement (QI) project assessed the introduction, spread and scale across Wales of an innovative role, Community Coordinators, funded by Welsh Government through the Save a Life Cymru programme. The project aimed to increase the emergency-ready status of the Welsh PAD fleet by 5% from a baseline of 89% by June 2024. Data from The Circuit supported establishment of baseline measures and ongoing data analytics during the study period (August 2022-July 2024).The introduction of Community Coordinators increased the proportion of Wales' emergency-ready PADs from 0.89 to 0.94. Process measures indicated firstly, an increase in registered PADs in Wales from 6415 to 8638. Secondly, the proportion of PADs registered with a PAD Guardian on The Circuit increased from 0.73 to 0.89.This QI project demonstrated that the problem of PAD non-readiness is complex, multifactorial and dynamic. Networked Community Coordinators to support volunteer PAD Guardians increased the emergency-ready status of the all-Wales defibrillator fleet. This innovative Welsh model could benefit wider UK and international communities.