Reduction of in-hospital cardiac arrest rates in intensive care-equipped New South Wales hospitals in association with implementation of Between the Flags rapid response system.
cardiac arrest
intensive care
medical emergency team
rapid response team
safety and quality
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
revised:
19
02
2020
received:
15
10
2019
accepted:
25
02
2020
pubmed:
7
3
2020
medline:
1
6
2021
entrez:
6
3
2020
Statut:
ppublish
Résumé
The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, in response to the death of a young patient, as a system-wide approach for early detection and management of the deteriorating patient in all NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously. To assess the impact of 'Between the Flags' (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW, on the incidence of in-hospital cardiac arrests and the incidence and outcome of patients admitted to an ICU following cardiac arrest and rapid response team activation. This is a prospective observational study of the BTF registry (August 2010 to June 2016) and the Australian and New Zealand Intensive Care Society Adult Patient Database (January 2008 to December 2016) in 35 New South Wales public hospitals with an ICU. The primary outcome studied was the proportion of in-hospital cardiac arrests. Secondary outcomes included changes in the severity of illness and outcomes of cardiac arrest admissions to the ICU and changes in the volume of rapid response calls. The cardiac arrest rate per 1000 hospital admissions declined from 0.91 in the implementation period to 0.70. Propensity score analysis showed significant declines in ICU and hospital mortality and length of stay for cardiac arrest patients admitted to the ICU (all P < 0.001). The BTF programme was associated with a significant reduction in cardiac arrests in hospitals and ICU admissions secondary to cardiac arrests in 35 NSW hospitals with an ICU.
Sections du résumé
BACKGROUND
BACKGROUND
The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, in response to the death of a young patient, as a system-wide approach for early detection and management of the deteriorating patient in all NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously.
AIM
OBJECTIVE
To assess the impact of 'Between the Flags' (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW, on the incidence of in-hospital cardiac arrests and the incidence and outcome of patients admitted to an ICU following cardiac arrest and rapid response team activation.
METHODS
METHODS
This is a prospective observational study of the BTF registry (August 2010 to June 2016) and the Australian and New Zealand Intensive Care Society Adult Patient Database (January 2008 to December 2016) in 35 New South Wales public hospitals with an ICU. The primary outcome studied was the proportion of in-hospital cardiac arrests. Secondary outcomes included changes in the severity of illness and outcomes of cardiac arrest admissions to the ICU and changes in the volume of rapid response calls.
RESULTS
RESULTS
The cardiac arrest rate per 1000 hospital admissions declined from 0.91 in the implementation period to 0.70. Propensity score analysis showed significant declines in ICU and hospital mortality and length of stay for cardiac arrest patients admitted to the ICU (all P < 0.001).
CONCLUSIONS
CONCLUSIONS
The BTF programme was associated with a significant reduction in cardiac arrests in hospitals and ICU admissions secondary to cardiac arrests in 35 NSW hospitals with an ICU.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
375-384Informations de copyright
© 2020 Royal Australasian College of Physicians.
Références
Winters BD, Pham J, Pronovost PJ. Rapid response teams - walk, don't run. JAMA 2006; 296: 1645-7.
Winters BD, Pham JC, Hunt EA, Guallar E, Berenholtz S, Pronovost PJ. Rapid response systems: a systematic review. Crit Care Med 2007; 35: 1238-43.
Steel AC, Reynolds SF. The growth of rapid response systems. Jt Comm J Qual Patient Saf 2008; 34: 489-95, 33.
Rosen MJ, Hoberman AJ, Reducing cardiopulmonary arrest rates in a three-year regional rapid response system collaborative. Jt Comm J Qual Patient Saf 2013; 39: 328-36.
Ludikhuize JB-RA, Dijkgraaf MG, Smorenburg SM, de Rooij SE, Adams R, de Maaijer PF et al. Cost and outcomes of medical emergency teams study group outcomes associated with the Nationwide introduction of rapid response systems in the Netherlands. Crit Care Med 2015; 43: 2544-5.
Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams: a systematic review and meta-analysis. Arch Intern Med 2010; 170: 18-26.
Barrett J, Hawdon G, Wade J, Reeves J. Measuring the success of medical emergency teams: potentially preventable deaths versus total cardiac arrest deaths. A single centre observational study. Intern Med J 2018; 48: 264-269.
Ball C, Kirkby M, Williams S. Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 2003; 327: 1014.
Garling, P. Final report of the special commission of inquiry: acute care services in NSW public hospitals [cited 2018 Jan 16]. Available from URL: https://www.dpc.nsw.gov.au/publications/special-commissions-of-inquiry/special-commission-of-inquiry-into-acute-care-services-in-new-south-wales-public-hospitals/
Pain C, Green M, Duff C, Hyland D, Pantle A, Fitzpatrick K et al. Between the flags: implementing a safety-net system at scale to recognise and manage deteriorating patients in the New South Wales Public Health system. Int J Qual Health Care 2017; 29: 130-6.
Chen J, Ou L, Flabouris A, Hillman K, Bellomo R, Parr M. Impact of a standardized rapid response system on outcomes in a large healthcare jurisdiction. Resuscitation 2016; 107: 47-56.
Frost SA, Chapman A, Aneman A, Chen J, Parr MJ, Hillman K. Hospital outcomes associated with introduction of a two-tiered response to the deteriorating patient. Crit Care Resusc 2015; 17: 77-82.
Paul E, Bailey M, Pilcher D. Risk prediction of hospital mortality for adult patients admitted to Australian and New Zealand intensive care units: development and validation of the Australian and New Zealand risk of death model. J Crit Care 2013; 28: 935-41.
Paul E, Bailey M, Kasza J, Pilcher D. The ANZROD model: better benchmarking of ICU outcomes and detection of outliers. Crit Care Resusc 2016; 18: 25-36.
Hillman K, Chen J, Brown D. A clinical model for health services research-the medical emergency team. J Crit Care 2003; 18: 195-9.
DeVita MA, Belloma R, Hillman K, Kellum J, Rotondi A, Teres D et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006; 34: 2463-78.
Jones DA, Bagshaw SM, Barrett J, Bellomo R, Bhatia G, Bucknall TK et al.The role of the medical emergency team in end-of-life care: a multicenter, prospective, observational study. Crit Care Med 2012; 40: 98-103.
Chen J, Flabouris A, Bellomo R, Hillman K, Finfer S; MERIT Study Investigators for the Simpson Centre and the ANZICS Clinical Trials Group. The medical emergency team system and not-for-resuscitation orders: results from the MERIT study. Resuscitation 2008; 79: 391-7.
Jones D, Bellomo R, DeVita M. Effectiveness of the medical emergency team: the importance of dose. Crit Care 2009; 13: 313.
Chen J, Bellomo R, Flabourins A, the MERIT Study Investigators for the Simpson Centre and the ANZICS Clinical Trials Group. The relationship between early emergency team calls and serious adverse events. Crit Care Med 2009; 37: 148-53.
NSW Government. Costs of Care Standards 2009/10-NSW Health. [cited 2017 Dec 12] Available from URL: https://www.semanticscholar.org/paper/Costs-of-Care-Standards-2009%2F10-NSW-Health-Branch/cfafea5aff081b7f4bf0cc6d1628b45d9f19debf
Martin C, Jones D, Wolfe R. State-wide reduction in in-hospital cardiac complications in association with introduction of a national standard for recognising deteriorating patients. Resuscitation 2017; 121: 172-8.
Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G et al. Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care 2005; 9: R808-R815.
Jones D, Bhasale A, Bailey M, Pilcher D, Anstey MH. Effect of a national standard for deteriorating patients on intensive care admissions due to cardiac arrest in Australia. Crit Care Med 2018; 46: 586-93.