Evaluating Compliance With Advance Care Directives and Resuscitation Plan Documentation in Patients Who Experienced Cardiac Arrest at a Regional Australian Hospital: A Retrospective Analysis

Introduction Advance Care Directives and Resuscitation Plans support patient-centred care for high-risk inpatients, particularly when clinical deterioration or end-of-life decision-making is anticipated. This audit aimed to evaluate compliance with Resuscitation Plan documentation requirements among patients who experienced an in-hospital cardiac arrest at a regional Australian hospital. Methods A retrospective clinical audit was conducted involving adult inpatients who experienced a cardiac arrest attended by the Medical Emergency Team over a 3.5-year period at a regional Australian hospital. Patients were identified from the ICU cardiac arrest logbook, and demographic, clinical, and documentation data were extracted from electronic medical records. Descriptive statistics were used to summarise documentation rates, comorbidities, admitting teams, Medical Emergency Team (MET) calls, and survival outcomes. Results Forty-seven inpatients experienced a cardiac arrest during the study period, with a mean age of 72.7 years and a mean pre-arrest length of hospital stay of 3.4 days. Only 17% had a documented Resuscitation Plan at the time of arrest, while 83% had none. Cardiovascular comorbidity was present in 85% of patients, and 23% had a MET response call before arrest; only three of these patients had a subsequent Resuscitation Plan documented. Eighteen patients survived their cardiac arrest, but only five had a Resuscitation Plan completed post-arrest. Conclusions Resuscitation Plan documentation was low in this elderly, high-risk inpatient cohort despite substantial comorbidity and a history of clinical deterioration in many patients. These findings suggest missed opportunities for earlier goals-of-care discussions and support targeted education and system-level interventions to improve documentation compliance.