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Reduction of in‐hospital cardiac arrest rates in intensive care‐equipped New South Wales hospitals in association with implementation of Between the Flags rapid response system
Author(s) -
Bhonagiri Deepak,
Lander Harvey,
Green Malcolm,
Straney Lahn,
Jones Daryl,
Pilcher David
Publication year - 2021
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14812
Subject(s) - medicine , emergency medicine , observational study , incidence (geometry) , intensive care unit , intensive care , intensive care medicine , medical emergency , physics , optics
Abstract Background The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, 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 NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously. Aim To assess 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 ICU following cardiac arrest and rapid response team activation. Methods This is a prospective observational study of the 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 an ICU. The 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 the ICU and changes in the volume of rapid response calls. Results 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 the ICU (all P < 0.001). Conclusions The BTF programme 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.