There is another way: empowering frontline staff caring for acutely unwell adults

Int J Qual Health Care. 2014 Feb;26(1):71-8. doi: 10.1093/intqhc/mzt084. Epub 2013 Nov 19.

Abstract

Quality problem or issue: It is estimated that only 17% of patients survive an in-hospital cardiac arrest. Medical evidence indicates that many patients show signs of deterioration during the 24 h period prior to their cardiac arrest.

Initial assessment: At Salford Royal NHS Foundation Trust (SRFT) 135 patients (outside critical care areas) suffered a cardiac arrest between March 2007 and April 2008.

Choice of solution: Quality improvement method-The breakthrough series (BTS) collaborative approach, change package-reliable manual vital signs, nurse-led response to the deteriorating patient, code red, structured ward round, ceilings of care, nurse-led do not attempt cardiopulmonary resuscitation (DNA-CPR) protocol and allocated roles.

Implementation: The project was delivered over two phases with a total of 23 wards (12 wards in Phase One and 11 wards in Phase Two). Frontline teams worked to develop changes with the aim of reducing cardiac arrests by 50%.

Evaluation: The primary outcome measure was the number of cardiac arrests per 1000 admissions outside of critical care areas. Process and balancing measures were also used to evaluate the impact of the intervention.

Lessons learned: The results showed a positive relationship between the change package and a reduction of 41% in cardiac arrests outside of critical care areas from the baseline period (April 2007-March 2008) to December 2012. The BTS model has the potential to reduce cardiac arrests without the need for initial large-scale financial investment.

Keywords: adverse events; cardiac arrests; hospital care; patient safety; quality improvement; quality measurement.

MeSH terms

  • Acute Disease / nursing
  • Acute Disease / therapy
  • Adult
  • Cardiopulmonary Resuscitation / methods
  • Cardiopulmonary Resuscitation / nursing
  • Cardiopulmonary Resuscitation / standards
  • Heart Arrest / epidemiology
  • Heart Arrest / prevention & control*
  • Heart Arrest / therapy
  • Hospital Administration / methods
  • Hospitals / standards
  • Hospitals / statistics & numerical data
  • Humans
  • Patient Care Team
  • Power, Psychological*
  • Quality Improvement / organization & administration
  • Quality Improvement / standards
  • Quality Indicators, Health Care / organization & administration
  • Quality Indicators, Health Care / statistics & numerical data
  • Quality of Health Care / organization & administration
  • Quality of Health Care / standards