Aim
The vast majority of in-hospital cardiac arrests are preceded by a period of physiological deterioration (Deakin et al 2010). It has been suggested that as many as 75% of all in-hospital cardiac arrests could be prevented (NCEPOD 2012). It is advocated that hospitals have mechanisms in place to review incidents of cardiac arrest. At The Princess Alexandra Hospital NHS Trust this was initially instigated by the Critical Care Outreach Team (CCOT), a homogenous group of nurses. Feedback from this process was good but nursing teams expressed concerns they were not involved in the process. A new method for review was instigated by the Resuscitation Service in 2019.

Method
Key clinical members of staff from the Trust were recruited to form a Cardiac Arrest Review Panel (CARP), including senior and junior nurses, senior medical staff, Resuscitation Practitioners, CCOT and Pharmacy staff. An objective data collection form incorporating best practice matrices from NICE, NCEPOD and RCP was developed. The collection form also looked at harm triggers as detailed in the Global Trigger Tool (GTT). A new governance process was created to support this change of practice which included time frames for “Hot reviews” of events and outcomes from CARPs. CARPS were held twice monthly and were designed to only last 15 minutes in duration. CARPs were held during protected mealtimes, facilitating greater attendance from ward staff. The panel would review data already gathered and look for notable practice, any care/service delivery (CSD) issues or opportunities where a discussion regarding resuscitation status was missed. Data is collated monthly and presented to Trust committees.

Results
The CARP has reviewed 25 incidents since January 2019 and has found:
7 incidents that had no Care or Service Delivery (CSD) issues
4 unrecognised predictable events were found
10 incidents that had a missed opportunity to review resuscitation status prior to arrest
4 incidents of CSD issues for immediate review
Conclusion
Feedback following the introduction of the CARP has been extremely positive. It allows a multi-professional approach to cardiac arrest reviews, utilising a novel objective assessment method. Nursing staff report a greater sense of engagement in the process allowing them to “own” any issues and actions. 
The introduction of the CARP has not only strengthened the governance processes around reviews, but has provided a conduit for learning from events which is shared both internally and externally with local commissioning groups, enhancing patient safety.

4 - Cardiac Arrest Review Panel (CARP)-a novel multi-professional approach to reviewing in-hospital cardiac arrests at an acute NHS Trust in Essex, UK.