Patient safety workstream – reducing cardiac arrests

Why cardiac arrests?

Set up in December 2010, the reducing cardiac arrests (deteriorating patient) workstream aims to reduce in-hospital mortality from avoidable cardiac arrests. Despite some trusts performing well against national benchmarks on mortality, there was variation amongst partners within our region.

What is the aim of the workstream?

The reducing cardiac arrests workstream, using community of practice methodology, set itself a bold vision of reducing in-hospital avoidable cardiac arrests by 50% versus an initial baseline in each trust. This aim will be delivered by focusing on key safety interventions and training ward staff in their reliable delivery.

Who is the lead?

John small


John Welch, Nurse Consultant in Critical Care, University College London Hospitals NHS Foundation Trust (UCLH)

John is a nurse consultant in critical care and outreach at UCLH, and clinical lead for the UCLPartners reducing cardiac arrests workstream. He is also clinical lead for the sepsis workstream in the UCLPartners patient safety programme. He has around 30 publications in the fields of acute and critical care. John is also working on two National Institute for Health Research (NIHR) funded research projects: a study of nurse-led psychological support for high-risk patients in ICU; and a study of cardiac arrests in over 100 hospitals. He is also a recipient and joint clinical lead of a Health Foundation Shine project grant.

Which trusts are participating?

When the workstream started, it covered five NHS trusts in north central London: it now encompasses 14 acute trusts across the UCLPartners region.

Successes of the workstream

Since the project started several trusts have achieved a sustained reduction in cardiac arrests over a number of years with certain trusts achieving up to 48% reduction. The ethos and bold vision of delivering improvement at scale, has encouraged engagement across traditional organisational boundaries – resulting in real benefits for patients. It has also spread innovation in terms of new ways of approaching daily work and increased staff satisfaction.

Evaluation data demonstrates increased reliability of recognising the signs of deterioration by wards and departments; increasingly prompt referral/escalation to senior staff; improved transfer times to intensive care units (ICU), where appropriate.

Current activities and next steps

Future success will see similar gains across all 14 trusts to those seen in the original five; further reducing avoidable cardiac arrests in all trusts; linking arrest reduction work to appropriate use of treatment escalation and supporting teams working in other areas to benefit from the systematic application of improvement methods. We will discuss sustainability and the potential for using the methodology in other clinical areas whilst maintaining current improvements over the coming months.

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