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Crit Care Med. 2018 Apr;46(4):586-593. doi: 10.1097/CCM.0000000000002951.

Effect of a National Standard for Deteriorating Patients on Intensive Care Admissions Due to Cardiac Arrest in Australia.

Author information

1
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
2
Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia.
3
Department of Intensive Care, The Alfred Hospital, Prahran, VIC, Australia.
4
The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Carlton, VIC, Australia.
5
Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.

Abstract

OBJECTIVES:

To assess whether a national standard for improving care of deteriorating patients affected ICU admissions following cardiac arrests from hospital wards.

DESIGN:

Retrospective study assessing changes from baseline (January 1, 2008, to June 30, 2010), rollout (July 1, 2010, to December 31, 2012), and after (January 1, 2013, to 31 December 31, 2014) national standard introduction. Conventional inferential statistics, interrupted time series analysis, and adjusted hierarchical multiple logistic regression analysis.

SETTING:

More than 110 ICU-equipped Australian hospitals.

PATIENTS OR SUBJECTS:

Adult patients (≥ 18 yr old) admitted to participating ICUs.

INTERVENTIONS:

Introducing a national framework to improve care of deteriorating patients including color-coded observation charts, mandatory rapid response system, enhanced governance, and staff education for managing deteriorating patients.

MEASUREMENTS AND MAIN RESULTS:

Cardiac arrest-related ICU admissions from the ward decreased from 5.6% (baseline) to 4.9% (rollout) and 4.1% (intervention period). Interrupted time series analysis revealed a decline in the rate of cardiac arrest-related ICU admissions in the rollout period, compared with the baseline period (p = 0.0009) with a subsequent decrease in the rate in the intervention period (p = 0.01). Cardiac arrest-related ICU admissions were less likely in the intervention period compared with the baseline period (odds ratio, 0.85; 95% CI, 0.78-0.93; p = 0.001), as was in-hospital mortality from cardiac arrests (odds ratio, 0.79; 95% CI, 0.65-0.96; p = 0.02).

CONCLUSIONS:

Introducing a national standard to improve the care of deteriorating patients was associated with reduced cardiac arrest-related ICU admissions and subsequent in-hospital mortality of such patients.

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