ABSTRACT
Data relating to survival from in-hospital cardiac arrest are used to audit staff performance and to help to determine whether new resuscitation techniques are effective. Individual studies into outcome from cardiac arrest have defined inclusion and exclusion criteria, but no such national criteria have been published to enable constant auditing of cardiac arrests. The aim of this survey was to investigate the consistency with which in-hospital cardiac arrests are recorded throughout the United Kingdom. Such data are, almost universally, collected by Resuscitation Officers (RO). A questionnaire was sent to ROs across the UK asking them to state how they would interpret and categorise hypothetical, but nonetheless typical, clinical situations involving a cardiac arrest team being called. These included an event where the patient had regained consciousness prior to the arrival of the cardiac team and also an event where rigor mortis was already present and the resuscitation promptly abandoned upon the arrival of the cardiac arrest team. The percentage survival to discharge of adult cardiac arrests for each hospital was also requested. This identified whether inclusion or exclusion of certain clinical events may have influenced cardiac arrest survival figures for that hospital. It is clear from this study that in-hospital clinical events when a cardiac arrest team is called are audited with a great deal of inconsistency. Some events, such as a patient who has rigor mortis, are excluded as a false or inappropriate call in some hospitals and included as an unsuccessful resuscitation in others. There is a need for guidance on the inclusion and exclusion criteria for auditing of cardiac arrests so that meaningful data can be obtained from across the UK and useful conclusions drawn. The situation at present will result in data being audited that are of limited use. In the era of evidence-based medicine, it seems vital to obtain accurate cardiac arrest survival figures in order to have any hope of improving them.
Subject(s)
Data Collection/standards , Heart Arrest/mortality , Hospitals , Medical Records/standards , Cardiopulmonary Resuscitation , Heart Arrest/therapy , Humans , Medical Audit , Survival RateABSTRACT
As flexibility and change become the only constants in health care delivery, providers are seeking improved methods for delivering quality, cost-effective services. Perinatal care is no exception. Length of stay is decreasing for obstetric patients, and the challenges of providing quality care are great. Outcomes management uses outcomes measures to improve clinical and functional results while better utilizing resources. Critical pathways and variances from that pathway are analyzed for opportunities to improve care and quality. Quality indicators are then derived from the variance data. The women's services outcomes manager, a new role, identifies and resolves quality issues.
Subject(s)
Managed Care Programs/organization & administration , Outcome Assessment, Health Care , Perinatology/organization & administration , Postnatal Care/organization & administration , Cost-Benefit Analysis , Female , Humans , Patient Care Planning , Quality Assurance, Health CareABSTRACT
A woman had clinically isolated renal failure caused by granulomatous sarcoid nephritis. At the onset of her illness, there were no historical, physical, or clinical features to suggest a definite causative diagnosis. After a renal biopsy specimen disclosed noncaseating epithelioid granulomas, a course of steroid therapy resulted in prompt disappearance of uremic symptoms and amelioration of her renal failure. Although leukopenia, delayed cellular immunity, and the response to steroids increased the suspicion that the patient had sarcoidosis, it was not until identical granulomas were obtained via mediastinal node biopsy that the diagnosis was confirmed. Sarcoidosis may occur as isolated renal failure. Renal biopsy is indicated to ensure early diagnosis and prompt treatment of this steroid-responsive lesions.
