Abstract Body: Introduction/Background: Pediatric In-Hospital Cardiac Arrest (P-IHCA) remains a critical patient safety and quality improvement issue. Conventional reviews often fail to capture early opportunities for recognition and prevention. This project addresses these gaps using structured, multidisciplinary reviews guided by experts in pediatric critical care and medical education.

Research Questions/Hypothesis: Does implementing a structured, multidisciplinary review methodology with a standardized process for both immediate and retrospective evaluations improve identification of preventable factors associated with P-IHCA.

Goals/Aims:
To enhance early recognition of clinical deterioration.
To systematically identify preventable factors and facilitate targeted interventions.
To foster multidisciplinary collaboration.

Methods/Approach: Structured reviews were conducted hospital-wide at a quaternary pediatric institution. The process included:
(1)- Immediate (hot) debriefs capturing real-time feedback on team performance, communication, and logistics.
(2)- Retrospective (cold) debriefs within one month, analyzing monitor data, patient records, and detailed staff interviews.
(3)- Systematic event classification using the eStablish And Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) into avoidable, potentially avoidable, or unavoidable.
(4)- Multidisciplinary follow-up through dedicated quality improvement pathways, maintaining expert review team involvement.

Results/Data: Structured hot debriefs identified real-time issues including communication failures, medication delays, and CPR quality concerns. Structured cold debriefs provided deeper systemic insights such as delays in recognizing clinical deterioration, diagnostic errors, and escalation failures. The reviews highlighted opportunities for improving interdepartmental communication, powered multidivisional collaborative event analyses, and subsequently informing meaningful changes in hospital policies, procedures, and staff training.

Conclusion(s): A structured, expert driven, multidisciplinary review process shifts event analysis from describing what happened during a cardiac arrest, to explaining why and how it occurred, thereby revealing upstream factors that improve recognition of decompensation, team response, and CPR performance. This approach facilitates targeted improvements, fostering a safer hospital environment, and potentially improving patient outcomes.