Purpose To implement and evaluate recommendations from the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) “Time to Intervene” report 2012. Material / method Following the publication of the NCEPOD report, the Resuscitation Department developed an action plan to implement Root Cause Analysis (RCA) following cardiac arrests in non-critical care areas. This would allow identification of specific learning needs and the implementation of plans to improve goals of care. RCA’s highlighted major failings in decision making with goals of care including DNACPR, due to either poor access to senior decision makers or a failure to set goals by medical staff. To improve the acute medical pathway the Trust plan included; the centralisation of acute medical patients onto the Hull Royal Infirmary site (leaving Cardiology and Oncology at Castle Hill Hospital) allowing better use of a 3rd medical registrar, ensuring there are no medical outliers on the Castle Hill site, the division of the Acute Assessment Unit (AAU) into two; Acute Medical Unit (AMU) and the Elderly Assessment Unit (EAU),with the intention of improving Consultant access, timely reviews and improved goals of care. Alongside these changes, an increased emphasis was placed during staff training; on the recognition of the deteriorating patient, understanding and utilisation of the National Early Warning Score and the DNACPR process. Staff were also empowered to ask for clear well documented decisions. Results Since the introduction of the Trust plan, we have seen a reduction in the number of futile/inappropriate resuscitation attempts and improvement in documented goals of care. National Cardiac Arrest Audit results highlight these improvements. Total Cardiac Arrests per year Year Number of CA’s/Year Survivors Admissions CA per 1000 14/15 319 58 (19.58%) 151646 2.10 15/16 304 66 (22.9%) 49138 2.03 16/17 260 61 (23.4%) 153277 1.69 Cardiac Arrests in Medical patients YEAR Number of CA CHH Number of CA HRI Total 2014/15 151 125 276 2015/16 120 139 259 2016/17 88 122 210 Conclusion Implementation of the NCEPOD recommendations within Hull and East Yorkshire Hospitals Trust has led to a reduction in the number of cardiac arrests within the Trust. References Time to Intervene? A review of patients who underwent cardiopulmonary resuscitation as a result of an in-hospital cardiorespiratory arrest. A report by the National Confidential Enquiry into Patient Outcome and Death (2012)
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