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Title: State-wide reduction in in-hospital cardiac complications in association with the introduction of a national standard for recognising deteriorating patients.
Austin Authors: Martin, Catherine;Jones, Daryl A ;Wolfe, Rory
Affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 30-Aug-2017
Date: 2017-12
Publication information: Resuscitation 2017; 121: 172-178
Abstract: To examine whether introducing a national standard to improve the recognition of and response to clinical deterioration, was associated with a reduction in cardiovascular events in the hospital environment. Interrupted time series was used to analyse the trajectories of monthly complication rates for 4.69 million admissions in 218 hospitals. Trajectory slopes determined for the "baseline period" (1 July 2007-30 June 2010) and the "Intervention period" (1 January 2013-30 June 2014) were compared (slope ratio). Before the intervention, complication rates due to arrhythmias were increasing, acute coronary syndrome (ACS) and all-cause mortality decreasing, but were constant for cardiac arrest and heart failure and pulmonary oedema. Analysis of the overall data suggested reduction in the rate of cardiac and ACS complications after the intervention, but no significant change in overall hospital mortality. Analysis by age category showed significant reductions in monthly rate trajectories in the 80 plus years age group for cardiac arrest (slope ratio 0.983, 95% CI: 0.972-0.994) and ACS (0.989, 95% CI: 0.981-0.997) complications. Slope ratios indicating reduced monthly rates were seen in females for cardiac arrest (0.985, 95% CI: 0.977-0.994), ACS (0.991, 95% CI: 0.984-0.998) and heart failure (0.993, 95% CI: 0.986-1.000) complications. There were also significant reductions in cardiac arrest (0.983, 95% CI: 0.969-0.996), ACS (0.991, 95% CI: 0.982-1.000) and arrhythmia (0.996, 95% CI: 0.994-0.998) complications for surgical patients. Introduction of a national standard for deteriorating hospitalised patients was associated with a reduction in the rates of in-hospital cardiac arrests and acute coronary syndromes in acute hospitals. Greatest benefit was seen in the elderly, female and surgical patients.
DOI: 10.1016/j.resuscitation.2017.08.240
Journal: Resuscitation
PubMed URL: 28860015
Type: Journal Article
Subjects: Cardiac complications
In-hospital cardiac arrest
National standards
Rapid response system
Rapid response team
Appears in Collections:Journal articles

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