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Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion
Author(s) -
Chen Jack,
Hillman Kenneth M
Publication year - 2015
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja14.01208
Subject(s) - association (psychology) , medicine , cardiopulmonary resuscitation , cardiology , emergency medicine , psychology , resuscitation , psychotherapist
Serious adverse events such as cardiac arrests and preventable deaths are common in acute hospitals,1,2 with a conservative estimate of 200 000 inhospital cardiopulmonary arrests (IHCAs)2 and up to 98 000 potentially preventable deaths each year in the United States.1 Many IHCAs and unexpected deaths3 are preceded by physiological instability and deteriorating vital signs for some hours before the event. Accordingly, they are potentially preventable. A rapid response system (RRS) consists of an afferent arm to identify deteriorating hospital patients, and an efferent arm to respond to such deterioration by rapidly deploying a team led by a physician or a nurse with appropriate critical care skills. The RRS was introduced to prevent serious adverse events such as ICHA and unexpected death.4 RRSs have now been implemented in many hospitals worldwide.5 There has been evidence for the effectiveness of RRSs from before-and-after studies,6,7 multicentre studies8,9 and systematic reviews.5,10 However, further level 1 evidence will be diffi cult if not impossible to achieve, due to the challenging ethics of randomly allocating patients into those receiving early or delayed intervention, the ubiquitous nature of RRSs in many parts of the world, and methodological diffi culties of randomising hospital clusters. Population-based studies have been used to measure the associated change in patient outcomes across a region following system implementation, such as in trauma systems.11,12 A population-based study, therefore, may provide a real-world perspective on the change in major outcomes such as IHCA and hospital mortality during a period of RRS implementation among hospitals across a health service region. The aim of this study was to examine the change in IHCA incidence, IHCA-related mortality and hospital mortality rates among acute hospitals within a large health jurisdiction in Australia, during a period of RRS expansion.