Avoiding adult in-hospital cardiac arrest: A retrospective cohort study to determine preventability.

INTRODUCTION: This study had three main aims. Develop a methodology for reviewing in-hospital cardiac arrests (IHCA). Assess appropriateness and potential preventability of IHCAs. Identify areas for improvement within the rapid response system (RRS). DESIGN: A retrospective cohort study of IHCA identified from an existing organisational electronic database of medical emergency (MET) and Code Blue team activation. Potential preventability of IHCA and Code Blue team activation were established by an expert panel based on a standardised case review process with descriptive and content analyses for each IHCA event. SETTING: A university affiliated tertiary referral hospital with an established two-tier RRS in Melbourne, Australia. PARTICIPANTS: Same day and multi-day stay patients identified from an existing database as having an IHCA defined as attempted resuscitation with chest compressions, defibrillation, or both from January 2014 to December 2015. MAIN OUTCOME MEASURES: Outcome measures were: number of Code Blue activations; potential preventability of Code Blue activations and potential preventability of the IHCA event. RESULTS: A total of 120 IHCA events equating to 0.58 per 1000 total admissions occurred. 11 (9%) of IHCA were determined to be potentially preventable due to a failure to escalate, medication errors and inappropriate management. 39 (33%) of 120 Code Blue team activations were determined to be potentially preventable. These were typically due to lack of identification and documentation for end of life (EOL) care in 16 (62%) cases and inappropriate resuscitation when limitations of care were already in place in 10 (38%) cases. CONCLUSIONS: The study centre has a comparably low rate of preventable IHCA which could be reduced further through improvements in documentation and handover process. A focus on improved communication, recognition and earlier instigation of appropriate EOL care will reduce this rate further.

Partnerships in intensive care unit (ICU): a new model of nursing care delivery.

AIM: The purpose of this project was to explore an alternate nursing workforce model in major public hospital in Melbourne, Australia. Drivers for this project included improving patient care, facilitating access to intensive care (ICU) beds and managing the changing nursing workforce challenges. METHODS: Using an exploratory descriptive design completed over two stages, a nursing partnership model with Enrolled Nurses (ENs) and experienced ICU nurses was piloted over a nine month period from May 2006. FINDINGS: Overall the partnership model was not sustainable. The positive outcomes included an improved focus on standards of patient care, maintaining access to ICU beds, skill enhancement for participating nurses and a general acceptance by staff to pilot alternate models of care in ICU. The challenges identified included managing changing patient acuity and patient allocation, staff turnover, and barriers to effectively transitioning the appointed Enrolled Nurses into this ICU setting. CONCLUSION: The resources and leadership required to implement the pilot were immense and the requirement did not lessen over time resulting in the pilot being unsustainable after nine months.