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Survival from cardiac arrest in an accident and emergency department: use as a performance indicator?
Insights
Cardiac arrest survival in emergency departments is a viable performance metric. Analyzing outcomes by arrest cause and rhythm allows for fair comparisons between departments.
Area of Science:
- Emergency Medicine
- Cardiology
- Healthcare Performance Measurement
Background:
- Cardiac arrest in emergency departments presents unique challenges.
- Assessing departmental performance is crucial for quality improvement.
Purpose of the Study:
- To evaluate patient outcomes following cardiac arrest within an emergency department.
- To determine if cardiac arrest survival is a suitable performance indicator for emergency departments.
Main Methods:
- A 6-year retrospective study (1991-1997) at a district general hospital's accident and emergency department.
- Analysis of cardiac arrest occurrences, rhythms (VT/VF vs. others), causes, and survival rates.
- Outcome measures included survival to hospital admission and hospital discharge.
Main Results:
- 77 cardiac arrests occurred; 55% survived to hospital admission.
- Ventricular tachycardia/fibrillation (VT/VF) arrests had an 81% survival to admission rate.
- Overall, 43% of patients survived to hospital discharge.
Conclusions:
- Cardiac arrest survival is a valuable, auditable performance measure for emergency departments.
- Standardizing comparisons by arrest etiology and rhythm enhances data validity.
- A national cardiac arrest outcome database could facilitate inter-departmental comparisons.
Objective:
To report the outcomes of patients with a cardiac arrest occurring in an accident and emergency department and discuss whether this would be an appropriate measure of performance of the department.
Design:
A 6-year retrospective study of cardiac arrests occurring within the accident and emergency department at a single hospital.
Setting:
A district general hospital accident and emergency department in the period 1991-1997.
Outcome Measures:
Survival to leave the emergency department, survival to leave hospital.
Results:
There were 77 cardiac arrests occurring within the department, and of these 42 (55%) survived to be admitted to hospital. Forty-two arrests involved a rhythm of VT/VF with 81% of these arrests surviving to be admitted. Thirty-five patients had other cardiac rhythms of whom 23% survived to admission. Primarily cardiac causes of arrest occurred in 52 patients with a survival rate of 60%. Overall 33 patients (43%) survived to be discharged from hospital.
Conclusion:
Survival from cardiac arrest is a useful measure of performance of an accident and emergency department. It is a condition that has definite outcomes, and is easily auditable. Figures can be compared between departments by comparing cases with the same aetiology or arrest rhythm thus reducing the influence of cases with a poorer outcome. This would provide an additional indicator for comparison of departments other than those currently used. A national database of outcome of cardiac arrests could be created to allow valid comparisons between departments.