Reduction of in hospital Cardiac arrest rates in Intensive care equipped NSW hospitals in association with Implementation of Between the Flags Rapid Response System.

Abstract

The NSW Clinical Excellence commission introduced the "Between the Flags" program in response to the death of a young patient as a system wide approach for early detection and management of the deteriorating patient in all 242 NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with ICUs has not been reported previously. This study assessed the impact of "Between the Flags" (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW on the incidence of in hospital cardiac arrests and the incidence and outcome of patients admitted to an Intensive Care Unit following cardiac arrest and rapid response team activation. Prospective observational study of BTF registry (August 2010 to June 2016), and the Australian and New Zealand Intensive Care Society Adult Patient Database (January 2008 to December 2016) in 35 New South Wales public hospitals with ICU. Primary outcome studied was the proportion of in hospital cardiac arrests. Secondary outcomes included changes in the severity of illness and outcomes of cardiac arrest admissions to ICU and changes in the volume of rapid response calls. The cardiac arrest rate per 1000 hospital admissions declined from 0.91 in the implementation period to 0.70. Propensity score analysis showed significant declines in ICU and hospital mortality, and length of stay for cardiac arrest patients admitted to ICU (all p < 0.001). The BTF program was associated with a significant reduction in cardiac arrests in hospitals and ICU admissions secondary to cardiac arrests in 35 NSW hospitals with an ICU. This article is protected by copyright. All rights reserved.