In County Durham and Darlington, we set out six years ago to reduce the number of cardiac arrests in our hospitals, through more effective management of deteriorating patients.
Our vision: The aim of the Cardiac Arrest Prevention Team at County Durham and Darlington NHS Foundation Trust was to shine a light on all the data surrounding cardiac arrest emergency calls in the trust’s hospitals and to use that analysis to identify training needs, both in specific areas and across the whole trust, which would improve patient outcomes and experience.
Where were we when we started? According to the latest National Cardiac Arrest Audit, the incident of cardiac arrest in hospital is 1.6 per 1000 hospital admissions with a survival rate of around 17 per cent. Unpublished local data suggested that there were an estimated 10-12 cardiac arrests per month in an acute hospital, with a survival to discharge rate of 14 per cent.
Making the Change: In-depth data analysis was needed in order to make the case for change. The data underlined clear training needs around palliative care; communication over the care of the sickest patients; and the management of family expectations when recovery might not be possible.
The programme was built on the following principles:
1. The need to gain a better understanding of the current position regarding cardiac arrests in the hospitals in County Durham and Darlington by gathering accurate, relevant data.
2. The importance of in depth case reviews to identify training needs.
3. The identification of “hot spots” requiring training and education.
4. The implementation of an electronic observation system to improve communication and support the sharing of good practice.
5. The need to build the case for the launch of the Acute Intervention Team to provide greater expertise in supporting ward staff in caring for deteriorating patients.
Results: As of a result of this programme and the hard work and teamwork from everyone involved, there has been a 46 per cent reduction in cardiac arrests amongst hospital patients in County Durham and Darlington.
The Cardiac Arrest Prevention team shone a light on the issue, but such a sustained and significant improvement has been brought about by the trust-wide commitment of the ward teams.
The trust now has an in-depth understanding of cardiac arrest incidence. Themes and problems can be identified much earlier, enabling focused intervention by clinical teams with a greater level of expertise.
