Better care results in fewer cardiac arrests

29 June 2017

The number of patients who suffer a cardiac arrest while an inpatient at Colchester General Hospital has fallen by 24%, new figures show.

A total of 62 inpatients had a cardiac arrest in 2016/17, compared with 82 the year before. It is the lowest figure since the hospital started to record the statistic in 2010/11, when the number of cardiac arrests was 117.

Data from the National Cardiac Arrest Audit (NCAA) for 2016/17 shows that the hospital had one of the best records of any hospital in the UK and Ireland in terms of in-hospital cardiac arrests per 1,000 hospital admissions.

Doctors and nurses at Colchester General Hospital say a significant part of the reduction results from improvements in the care of deteriorating patients.

Dr Joe Adams, consultant anaesthetist, said the issue of deteriorating patients was one of the 11 workstreams of the Trust’s Every Patient, Every Day (EPED) transformation programme.

“Unfortunately, some cardiac arrests are totally unforeseen and in those situations there is often little that we can do to prevent the arrest,” he said.

“However, if we pick up signs of deterioration as soon as possible, it means we can intervene clinically in the most timely way, which reduces the risk of a cardiac arrest.

“The success we are seeing is the result of teamwork, which has included various audits to highlight the issue, a rejuvenated training package and additional resources, including the appointment of an additional full-time resuscitation officer.”

Dr Adams said that when the hospital’s performance on in-hospital cardiac arrests is benchmarked against other hospitals, Colchester Hospital University NHS Foundation Trust was consistently in the top 20% of acute trusts.

In 2013, the Trust replaced its own clinical observations early warning system with national best practice guidelines called the National Early Warning Score (NEWS), developed by the Royal College of Physicians.

It is a surveillance system for tracking the clinical condition of patients, alerting staff to any deterioration and triggering a timely response.

NEWS is based on a simple scoring system that monitors observations such as temperature, blood pressures, pulse rate and respiratory rate.

The appointment of an additional resuscitation training officer brings the total to two whole time equivalent positions at the Trust. It has enabled the Trust to complete more cardiac arrest reviews, provide more education around DNACPR – Do Not Attempt Cardiopulmonary Resuscitation – decisions and to rejoin the NCAA.

A new training programme has been introduced at Colchester General Hospital called RED (Recognition of Escalation and Deterioration), which is provided by specialist nurses to registered nurses and healthcare assistants.

EPED’s deteriorating patient workstream includes a Trust-wide programme for the assessment and management of sepsis, a leading cause of avoidable patient mortality.

For example, last month, Dr Stephen Bolsin, an international patient safety expert based in Australia, visited the hospital to help staff diagnose and treat the illness, which claims more than 35,000 UK lives a year.

Another factor contributing to a reduction of in-hospital cardiac arrests is the better use of DNACPR orders.

Due to the low success of CPR and the corresponding high risk of complications, which include brain damage leading to disability, for many people, particularly those with terminal illnesses, a decision is made with their clinical team that CPR will not be attempted. In these situations, a DNACPR order is completed.