Reducing cardiac arrests in the acute admissions unit: a quality improvement journey

Daniel J. Beckett, Monica Inglis, Sharon Oswald, Elaine Thomson, Wilma Harley, Jennifer Wilson, Robert C. Lloyd, Kevin D. Rooney

Research output: Contribution to journalArticle

Abstract

Background In 2010, the acute admissions unit (AAU) at Stirling Royal Infirmary had the highest number of cardiac arrests of any ward. A quality improvement project was undertaken to reduce this to <1/1000 admissions by December 2011. Methods In January 2011, based on initial needs assessment, we selected three initiatives to improve cardiac arrest rate: (1) structured response to deteriorating patients; (2) analysis of adverse events; and (3) improved end-of-life decision-making. We performed a failure modes effects analysis to identify reasons for the failure of early recognition and response. Ward staff conducted weekly safety meetings to engage unit staff and promote a safety culture of continuous improvement. Additionally, in July 2011 the unit adopted a ward-based clinical team structure with twice daily consultant ward rounds. Our primary outcome measure, cardiac arrests per 1000 admissions, was measured from January 2011 to August 2012. Results Over 17months, the number of cardiac arrests per 1000 admissions fell from a baseline of 2.8/1000 admissions to 0.8/1000 admissions (71% reduction), referrals to palliative care increased by 22 to 37/1000 admissions per month (68% increase) and the 30-day mortality of patients admitted to the AAU fell from 6.3% to 4.8% (24% relative reduction). Conclusions Through adoption of a shared goal, application of improvement methodology including the model for improvement to test new innovations, and promotion of a safety culture in the AAU, cardiac arrests were successfully reduced to <1/1000 admissions per month with an associated significant fall in mortality. This was achieved with negligible cost.
Original languageEnglish
Pages (from-to)1025-1031
JournalBMJ Quality and Safety
Volume22
Issue number12
DOIs
Publication statusPublished - Dec 2013

Keywords

  • Checklists
  • Communication
  • Control charts
  • run charts
  • Patient safety
  • PDSA

Cite this

Beckett, Daniel J. ; Inglis, Monica ; Oswald, Sharon ; Thomson, Elaine ; Harley, Wilma ; Wilson, Jennifer ; Lloyd, Robert C. ; Rooney, Kevin D. / Reducing cardiac arrests in the acute admissions unit: a quality improvement journey. In: BMJ Quality and Safety. 2013 ; Vol. 22, No. 12. pp. 1025-1031.
@article{95d5bff8c1be4f38a37f62c677a42443,
title = "Reducing cardiac arrests in the acute admissions unit: a quality improvement journey",
abstract = "Background In 2010, the acute admissions unit (AAU) at Stirling Royal Infirmary had the highest number of cardiac arrests of any ward. A quality improvement project was undertaken to reduce this to <1/1000 admissions by December 2011. Methods In January 2011, based on initial needs assessment, we selected three initiatives to improve cardiac arrest rate: (1) structured response to deteriorating patients; (2) analysis of adverse events; and (3) improved end-of-life decision-making. We performed a failure modes effects analysis to identify reasons for the failure of early recognition and response. Ward staff conducted weekly safety meetings to engage unit staff and promote a safety culture of continuous improvement. Additionally, in July 2011 the unit adopted a ward-based clinical team structure with twice daily consultant ward rounds. Our primary outcome measure, cardiac arrests per 1000 admissions, was measured from January 2011 to August 2012. Results Over 17months, the number of cardiac arrests per 1000 admissions fell from a baseline of 2.8/1000 admissions to 0.8/1000 admissions (71{\%} reduction), referrals to palliative care increased by 22 to 37/1000 admissions per month (68{\%} increase) and the 30-day mortality of patients admitted to the AAU fell from 6.3{\%} to 4.8{\%} (24{\%} relative reduction). Conclusions Through adoption of a shared goal, application of improvement methodology including the model for improvement to test new innovations, and promotion of a safety culture in the AAU, cardiac arrests were successfully reduced to <1/1000 admissions per month with an associated significant fall in mortality. This was achieved with negligible cost.",
keywords = "Checklists, Communication, Control charts, run charts, Patient safety, PDSA",
author = "Beckett, {Daniel J.} and Monica Inglis and Sharon Oswald and Elaine Thomson and Wilma Harley and Jennifer Wilson and Lloyd, {Robert C.} and Rooney, {Kevin D.}",
year = "2013",
month = "12",
doi = "10.1136/bmjqs-2012-001404",
language = "English",
volume = "22",
pages = "1025--1031",
journal = "BMJ Quality and Safety",
issn = "2044-5415",
publisher = "BMJ Publishing Group",
number = "12",

}

Beckett, DJ, Inglis, M, Oswald, S, Thomson, E, Harley, W, Wilson, J, Lloyd, RC & Rooney, KD 2013, 'Reducing cardiac arrests in the acute admissions unit: a quality improvement journey' BMJ Quality and Safety, vol. 22, no. 12, pp. 1025-1031. https://doi.org/10.1136/bmjqs-2012-001404

Reducing cardiac arrests in the acute admissions unit: a quality improvement journey. / Beckett, Daniel J.; Inglis, Monica; Oswald, Sharon; Thomson, Elaine; Harley, Wilma; Wilson, Jennifer; Lloyd, Robert C.; Rooney, Kevin D.

In: BMJ Quality and Safety, Vol. 22, No. 12, 12.2013, p. 1025-1031.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reducing cardiac arrests in the acute admissions unit: a quality improvement journey

AU - Beckett, Daniel J.

AU - Inglis, Monica

AU - Oswald, Sharon

AU - Thomson, Elaine

AU - Harley, Wilma

AU - Wilson, Jennifer

AU - Lloyd, Robert C.

AU - Rooney, Kevin D.

PY - 2013/12

Y1 - 2013/12

N2 - Background In 2010, the acute admissions unit (AAU) at Stirling Royal Infirmary had the highest number of cardiac arrests of any ward. A quality improvement project was undertaken to reduce this to <1/1000 admissions by December 2011. Methods In January 2011, based on initial needs assessment, we selected three initiatives to improve cardiac arrest rate: (1) structured response to deteriorating patients; (2) analysis of adverse events; and (3) improved end-of-life decision-making. We performed a failure modes effects analysis to identify reasons for the failure of early recognition and response. Ward staff conducted weekly safety meetings to engage unit staff and promote a safety culture of continuous improvement. Additionally, in July 2011 the unit adopted a ward-based clinical team structure with twice daily consultant ward rounds. Our primary outcome measure, cardiac arrests per 1000 admissions, was measured from January 2011 to August 2012. Results Over 17months, the number of cardiac arrests per 1000 admissions fell from a baseline of 2.8/1000 admissions to 0.8/1000 admissions (71% reduction), referrals to palliative care increased by 22 to 37/1000 admissions per month (68% increase) and the 30-day mortality of patients admitted to the AAU fell from 6.3% to 4.8% (24% relative reduction). Conclusions Through adoption of a shared goal, application of improvement methodology including the model for improvement to test new innovations, and promotion of a safety culture in the AAU, cardiac arrests were successfully reduced to <1/1000 admissions per month with an associated significant fall in mortality. This was achieved with negligible cost.

AB - Background In 2010, the acute admissions unit (AAU) at Stirling Royal Infirmary had the highest number of cardiac arrests of any ward. A quality improvement project was undertaken to reduce this to <1/1000 admissions by December 2011. Methods In January 2011, based on initial needs assessment, we selected three initiatives to improve cardiac arrest rate: (1) structured response to deteriorating patients; (2) analysis of adverse events; and (3) improved end-of-life decision-making. We performed a failure modes effects analysis to identify reasons for the failure of early recognition and response. Ward staff conducted weekly safety meetings to engage unit staff and promote a safety culture of continuous improvement. Additionally, in July 2011 the unit adopted a ward-based clinical team structure with twice daily consultant ward rounds. Our primary outcome measure, cardiac arrests per 1000 admissions, was measured from January 2011 to August 2012. Results Over 17months, the number of cardiac arrests per 1000 admissions fell from a baseline of 2.8/1000 admissions to 0.8/1000 admissions (71% reduction), referrals to palliative care increased by 22 to 37/1000 admissions per month (68% increase) and the 30-day mortality of patients admitted to the AAU fell from 6.3% to 4.8% (24% relative reduction). Conclusions Through adoption of a shared goal, application of improvement methodology including the model for improvement to test new innovations, and promotion of a safety culture in the AAU, cardiac arrests were successfully reduced to <1/1000 admissions per month with an associated significant fall in mortality. This was achieved with negligible cost.

KW - Checklists

KW - Communication

KW - Control charts

KW - run charts

KW - Patient safety

KW - PDSA

U2 - 10.1136/bmjqs-2012-001404

DO - 10.1136/bmjqs-2012-001404

M3 - Article

VL - 22

SP - 1025

EP - 1031

JO - BMJ Quality and Safety

JF - BMJ Quality and Safety

SN - 2044-5415

IS - 12

ER -

Beckett DJ, Inglis M, Oswald S, Thomson E, Harley W, Wilson J et al. Reducing cardiac arrests in the acute admissions unit: a quality improvement journey. BMJ Quality and Safety. 2013 Dec;22(12):1025-1031. https://doi.org/10.1136/bmjqs-2012-001404