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Quality of in-hospital cardiac arrest calls : a prospective observational study
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Akhtar, Naheed, Field, R. A., Greenwood, L., Davies, Robin P., Woolley, S., Cooke, Matthew (Professor of clinical systems design) and Perkins, Gavin D. (2012) Quality of in-hospital cardiac arrest calls : a prospective observational study. BMJ Quality and Safety, Vol.21 (No.3). pp. 184-190. doi:10.1136/bmjqs-2011-000319 ISSN 2044-5415.
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Official URL: http://dx.doi.org/10.1136/bmjqs-2011-000319
Abstract
Objective: To determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls. Design: Prospective observational study. Setting: Three National Health Service acute hospitals in England. Participants: Adult patients sustaining an in-hospital cardiac arrest (CA) or medical emergency (ME) which required activation of the hospital resuscitation team between 1 December 2009 and 30 April 2010. Main outcome measures: Emergency call duration, emergency team dispatch time, diagnostic accuracy of emergency call (sensitivity/specificity), thematic analysis of emergency call, patient outcomes (return of spontaneous circulation and survival to hospital discharge). Results: There were 426 adult resuscitation team activations. There was variability in emergency call duration ranging from 6 to 92 s (median 15 s; IQR 12-19). The sensitivity and specificity of calls for a CA was 91% (86.4-94.6%) and 62% (55.5-68.7%), respectively. Sensitivity did not change with call duration but specificity increased from 38% (25.8-51.0%) for the shortest calls to 82% (69.5-89.6%) for longer calls; p=0.03. The return of spontaneous circulation rate was 38% for calls when the patient was confirmed as in CA upon arrival of the resuscitation team. Survival to hospital discharge rates was higher in patients with shorter call durations (26%) than calls with longer call duration (12%); p=0.028. Five themes emerged identifying reasons for the increased call delay. Conclusion: There is variability in duration and diagnostic accuracy of in-hospital emergency calls. This is associated with delayed activation of the emergency response. The attempt to differentiate between ME and CA is a source of confusion. A single clinical emergency response for CA and ME calls may provide a more focused and timely emergency response.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > R Medicine (General) | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
Journal or Publication Title: | BMJ Quality and Safety | ||||||||
Publisher: | B M J Group | ||||||||
ISSN: | 2044-5415 | ||||||||
Official Date: | March 2012 | ||||||||
Dates: |
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Volume: | Vol.21 | ||||||||
Number: | No.3 | ||||||||
Page Range: | pp. 184-190 | ||||||||
DOI: | 10.1136/bmjqs-2011-000319 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access |
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