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

Jones, Daryl BSc(Hons), MBBS, FRACP, FCICM, MD, PhD1; Bhasale, Alice BSc (Psychol), MSc (Med)2; Bailey, Michael PhD, MSc(statistics), BSc(Hons)1; Pilcher, David MBBS, MRCP(UK), FRACP, FCICM1,3,4; Anstey, Matthew H. MBBS, MPH FCICM2,5

doi: 10.1097/CCM.0000000000002951
Clinical Investigations

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.

1School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

2Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia.

3Department of Intensive Care, The Alfred Hospital, Prahran, VIC, Australia.

4The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Carlton, VIC, Australia.

5Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.

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Drs. Jones’ and Bailey’s institution received funding from Australian Commission on Safety and Quality in Health Care (ACSQHC). Dr. Jones disclosed that the ACSQHC funded the statistical analysis, but had no access to the data, and no role in the analysis. Ms. Bhasale and Dr. Anstey provided comments on interpretation of results, but the final interpretation was up to authors Drs. Jones, Bailey, and Pilcher. He disclosed that he is an honorary advisor to ACSQHC, and he disclosed government work. Ms. Bhasale disclosed work for hire, and she disclosed that the ACSQHC is an independent statutory authority jointly funded by the Australian, state, and territory governments. The Commission is responsible for developing the National Safety and Quality Health Service (NSQHS) Standards, the impact of which are described in this investigation. The Commission funded the data analysis as part of funding received through the Australian Government Department of Health. As an employee of the Commission, she participated in the work as part of her employment, but neither she nor the Commission had any role in designing or conducting the analysis. Dr. Anstey disclosed that this work is derived from an evaluation of the National Standards in Australia, funded by the ACSQHC. He was an employee of the Commission as a medical advisor; however, this work is an unfunded extension of that evaluation. Dr. Pilcher has disclosed that he does not have any potential conflicts of interest.

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