Abstract
Purpose of the study
To explore whether variation in in-hospital cardiac arrest (IHCA) survival can be
explained by differences in resuscitation service provision across UK acute hospitals.
Methods
We linked information on key clinical practices with patient data of adults who had
a cardiac arrest on a general hospital ward or emergency admissions unit in 2016/17.
We used multi-level Bayesian models to explore associations between system quality
indicators (number of resuscitation officers, audits time to first shock, review unexpected
non-survivors, arrest team meets at handover, hot debrief, cold debrief, real-time
audio-visual feedback, frequency of mock arrest provision) and adjusted hospital survival.
Results
We received survey responses from 110 out of 180 eligible hospitals (response rate
61%) relating to 12,285 cardiac arrest cases. Variation across trusts was observed
in the number of resuscitation officers (median 0.7 (interquartile range 0.5, 0.9)
per 750 clinical staff employed. Key system quality indicators were undertaken infrequently:
audit of time to first shock (44.7%), arrest team meeting at handover (28.9%), mock
arrests ≥ monthly (22.4%), and use of CPR feedback devices (18.4%). The probability
that the system quality indicators had a positive effect on hospital survival ranged
from 10% to 89%. However, there was uncertainty in the estimated odds ratios and we
cannot exclude the possibility of a clinical benefit. Findings were consistent across
secondary outcomes.
Conclusion
In this study, we identified variation in implementation of system quality indicators.
Amongst hospitals that responded to our survey, the probability that individual factors
increase the odds of hospital survival ranges from 10 to 89%.
Keywords
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Article info
Publication history
Published online: April 15, 2020
Accepted:
April 5,
2020
Received in revised form:
March 10,
2020
Received:
January 8,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
