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Reply to Letter: Incidence and outcome of in-hospital cardiac arrest in the United Kingdom Cardiac Arrest Audit—Can we clarify our purpose and shift the paradigm?
Resuscitation 86 (2015) e1
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Reply to Letter: Incidence and outcome of inhospital cardiac arrest in the United Kingdom Cardiac Arrest Audit—Can we clarify our purpose and shift the paradigm? Sir, We note with interest the NCCA audit report which describes a national cardiac arrest rate of 1.6/1000 admissions within a United Kingdom context. We believe that cardiac arrests (with resuscitation attempts) in acutely unwell adult in-patients (excluding intensive care units, coronary care units and accident and emergency departments) often represent avoidable harm and that prevention is better than cure. This is especially relevant for cardiac arrests where outcomes are particularly poor.1 In 2012 an NCEPOD report found cardiac arrests were predictable in 64% of cases and avoidable in 38%.1 A recent review of patient safety incidents in England by Sir Liam Donaldson and Lord Ara Darzi, concluded there was a failure to recognize deterioration in 23% of incidents and a mismanagement in 35%.2 We believe that improving anticipatory care, prediction and planning as well as recognition and response to people with physiological deterioration can dramatically reduce cardiac arrests. We liken cardiac arrests in acute hospitals to some of the other harms that were once seen as inevitable consequences of care. For example ventilator associated pneumonia and central venous catheter related bloodstream infections. Through rigorous application of quality improvement approaches these common and devastating complications have been greatly reduced. We represent and work within three large UK healthcare systems (UCLPartners Academic Health Science Network, Salford Royal NHS Foundation Trust and The Scottish Patient Safety Programme) that have committed to reducing cardiac arrests and are working together through a community of practice with this explicit aim. Across our healthcare systems we have achieved a significant reduction in cardiac arrests. An applied Quality Improvement approach has contributed to success in demonstrating a sustained reduction in cardiac arrests.3,4 The AMU (Acute Medical Unit) in Forth Valley Royal Hospital and Salford Royal NHS Foundation Trust achieved a 71% and 41% reduction respectively in their cardiac arrest rates to 0.8/1000 admissions (considerably lower than the national amalgamated figure). University College London Hospitals has a 49% reduction with no increase in DNACPR rate and St John’s Hospital (NHS Lothian) has experienced a 57% reduction in cardiac arrests (unpublished data). The Scottish Patient Safety Programme encourages Health Boards and hospitals to count and report cardiac arrests with the
http://dx.doi.org/10.1016/j.resuscitation.2014.07.022 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.
aim of reducing them and learning from the variation between systems to support improvement across all our hospitals. The authors believe the NCAA report should help direct improvement efforts to prevent cardiac arrests. In order to measure and monitor safety rigorously Charles Vincent in his Health Foundation report5 recommends that healthcare becomes sensitive at predicting harm in a truly generative way. We would be pleased to work with other groups or individuals that share our common goal of improving the safety and quality of care we all deliver. We believe that there are opportunities for the NCAA to shift their focus to upstream prevention rather than measuring past harm in isolation. Conflict of interest statement There are no conflicts of interest to declare for all of the authors. References 1. Findlay GP, Shotton H, Kelly K, Mason M. Cardiac arrest procedures: time to intervene? NCEPOD; 2012. 2. Donaldson L, Panesar S, Darzi A. Patient safety related hospital deaths in England: thematic analysis of Incidents Reported to a National Database, 2010–2012. PLoS Med 2014. 3. Turkington P. There is another way: empowering frontline staff caring for the acutely unwell adults. Int J Qual Health Care 2013;10:1093. 4. Beckett D, Inglis M, Oswald S, et al. Reducing cardiac arrests in the acute admissions unit: a quality improvement journey. BMJ Qual Saf 2013;22: 1025–31. 5. Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation; 2013.
Charlotte Hopkins ∗ Peter Turkington Daniel Beckett John Welch Alison Hunter Iain Keith James Mountford Andrew Longmate UCLPartners, 3rd Floor 170 Tottenham, Court Road, London W1T 7HA, United Kingdom ∗ Corresponding
author. E-mail address: [email protected] (C. Hopkins) 25 July 2014
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Reply to Letter: Incidence and outcome of inhospital cardiac arrest in the United Kingdom Cardiac Arrest Audit—Can we clarify our purpose and shift the paradigm? Sir, We note with interest the NCCA audit report which describes a national cardiac arrest rate of 1.6/1000 admissions within a United Kingdom context. We believe that cardiac arrests (with resuscitation attempts) in acutely unwell adult in-patients (excluding intensive care units, coronary care units and accident and emergency departments) often represent avoidable harm and that prevention is better than cure. This is especially relevant for cardiac arrests where outcomes are particularly poor.1 In 2012 an NCEPOD report found cardiac arrests were predictable in 64% of cases and avoidable in 38%.1 A recent review of patient safety incidents in England by Sir Liam Donaldson and Lord Ara Darzi, concluded there was a failure to recognize deterioration in 23% of incidents and a mismanagement in 35%.2 We believe that improving anticipatory care, prediction and planning as well as recognition and response to people with physiological deterioration can dramatically reduce cardiac arrests. We liken cardiac arrests in acute hospitals to some of the other harms that were once seen as inevitable consequences of care. For example ventilator associated pneumonia and central venous catheter related bloodstream infections. Through rigorous application of quality improvement approaches these common and devastating complications have been greatly reduced. We represent and work within three large UK healthcare systems (UCLPartners Academic Health Science Network, Salford Royal NHS Foundation Trust and The Scottish Patient Safety Programme) that have committed to reducing cardiac arrests and are working together through a community of practice with this explicit aim. Across our healthcare systems we have achieved a significant reduction in cardiac arrests. An applied Quality Improvement approach has contributed to success in demonstrating a sustained reduction in cardiac arrests.3,4 The AMU (Acute Medical Unit) in Forth Valley Royal Hospital and Salford Royal NHS Foundation Trust achieved a 71% and 41% reduction respectively in their cardiac arrest rates to 0.8/1000 admissions (considerably lower than the national amalgamated figure). University College London Hospitals has a 49% reduction with no increase in DNACPR rate and St John’s Hospital (NHS Lothian) has experienced a 57% reduction in cardiac arrests (unpublished data). The Scottish Patient Safety Programme encourages Health Boards and hospitals to count and report cardiac arrests with the
http://dx.doi.org/10.1016/j.resuscitation.2014.07.022 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.
aim of reducing them and learning from the variation between systems to support improvement across all our hospitals. The authors believe the NCAA report should help direct improvement efforts to prevent cardiac arrests. In order to measure and monitor safety rigorously Charles Vincent in his Health Foundation report5 recommends that healthcare becomes sensitive at predicting harm in a truly generative way. We would be pleased to work with other groups or individuals that share our common goal of improving the safety and quality of care we all deliver. We believe that there are opportunities for the NCAA to shift their focus to upstream prevention rather than measuring past harm in isolation. Conflict of interest statement There are no conflicts of interest to declare for all of the authors. References 1. Findlay GP, Shotton H, Kelly K, Mason M. Cardiac arrest procedures: time to intervene? NCEPOD; 2012. 2. Donaldson L, Panesar S, Darzi A. Patient safety related hospital deaths in England: thematic analysis of Incidents Reported to a National Database, 2010–2012. PLoS Med 2014. 3. Turkington P. There is another way: empowering frontline staff caring for the acutely unwell adults. Int J Qual Health Care 2013;10:1093. 4. Beckett D, Inglis M, Oswald S, et al. Reducing cardiac arrests in the acute admissions unit: a quality improvement journey. BMJ Qual Saf 2013;22: 1025–31. 5. Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation; 2013.
Charlotte Hopkins ∗ Peter Turkington Daniel Beckett John Welch Alison Hunter Iain Keith James Mountford Andrew Longmate UCLPartners, 3rd Floor 170 Tottenham, Court Road, London W1T 7HA, United Kingdom ∗ Corresponding
author. E-mail address: [email protected] (C. Hopkins) 25 July 2014