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Avoiding adult in-hospital cardiac arrest: A retrospective cohort study to determine preventability
Gordon Bingham1, Irma Bilgrami2, Mandy Sandford1
1Alfred Hospital, Melbourne, Victoria, Australia.
Insights
This study found that 9% of in-hospital cardiac arrests (IHCA) and 33% of rapid response system (RRS) activations were preventable. Improving documentation and end-of-life care communication can reduce these rates.
Area of Science:
- Medical emergency response systems
- Cardiology
- Patient safety
Background:
- In-hospital cardiac arrests (IHCA) and rapid response system (RRS) activations require rigorous review to ensure patient safety and system efficiency.
- Assessing the preventability of these events is crucial for quality improvement in healthcare settings.
Purpose of the Study:
- To develop a methodology for reviewing IHCA.
- To assess the appropriateness and preventability of IHCAs.
- To identify areas for improvement within the RRS.
Main Methods:
- A retrospective cohort study analyzed IHCA events from an electronic database.
- An expert panel reviewed cases to determine potential preventability of IHCA and RRS activations.
- Descriptive and content analyses were performed on each IHCA event.
Main Results:
- 120 IHCA events were identified, with 11% deemed potentially preventable due to issues like failure to escalate or medication errors.
- 33% of 120 RRS activations were potentially preventable, often linked to inadequate end-of-life (EOL) care documentation or inappropriate resuscitation efforts.
- The study site demonstrated a relatively low rate of preventable IHCA.
Conclusions:
- The study identified opportunities to further reduce preventable IHCAs through enhanced documentation and handover processes.
- Improved communication, recognition of patient decline, and timely initiation of EOL care are key to reducing preventable events.
- The findings highlight the importance of a robust RRS and continuous quality improvement in critical care.
Introduction:
This study had three main aims. Develop a methodology for reviewing in-hospital cardiac arrests (IHCA). Assess appropriateness and potential preventability of IHCAs. Identify areas for improvement within the rapid response system (RRS).
Design:
A retrospective cohort study of IHCA identified from an existing organisational electronic database of medical emergency (MET) and Code Blue team activation. Potential preventability of IHCA and Code Blue team activation were established by an expert panel based on a standardised case review process with descriptive and content analyses for each IHCA event.
Setting:
A university affiliated tertiary referral hospital with an established two-tier RRS in Melbourne, Australia.
Participants:
Same day and multi-day stay patients identified from an existing database as having an IHCA defined as attempted resuscitation with chest compressions, defibrillation, or both from January 2014 to December 2015.
Main Outcome Measures:
Outcome measures were: number of Code Blue activations; potential preventability of Code Blue activations and potential preventability of the IHCA event.
Results:
A total of 120 IHCA events equating to 0.58 per 1000 total admissions occurred. 11 (9%) of IHCA were determined to be potentially preventable due to a failure to escalate, medication errors and inappropriate management. 39 (33%) of 120 Code Blue team activations were determined to be potentially preventable. These were typically due to lack of identification and documentation for end of life (EOL) care in 16 (62%) cases and inappropriate resuscitation when limitations of care were already in place in 10 (38%) cases.
Conclusions:
The study centre has a comparably low rate of preventable IHCA which could be reduced further through improvements in documentation and handover process. A focus on improved communication, recognition and earlier instigation of appropriate EOL care will reduce this rate further.
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