Reducing cardiac arrests for people at risk of deterioration in hospital care
Recognising and responding to deteriorating hospitalised patients is an important issue. Research identified mismanaged deterioration as the most common safety related incident in acute settings. By closely monitoring and observing patients, staff are able to recognise a person’s deteriorating health. This allows clinical staff to work with patients to support person centred decision-making, plan care and provide treatment as soon as possible. In some cases, this can reduce the chances of cardiac arrest and death.
The Scottish Patient Safety Programme’s (SPSP) Acute Adult improvement work supports clinical teams within NHS boards to improve the recognition of and response to hospital patients who are deteriorating.
We developed a driver diagram, change package and measurement plan, and we track progress of the positive impact of our work with clinical teams. The key improvements are:
- Early recognition of acute physiological deterioration through the National Early Warning Score (NEWS). NEWS is an evidence-based tool that assists staff to recognise and communicate deterioration, including sepsis, as early as possible. NHS boards across Scotland now use the NEWS tool.
- Improved response to a deteriorating patient. This allows staff to plan and provide treatment as soon as possible to reduce the chance of a cardiac arrest and provide prompt treatment for sepsis.
- Person centred decision making to support an individual’s needs and choices.
- Communication of people at risk of deterioration and their treatment plan.
The SPSP Acute Adult programme developed NEWS educational cards and posters for clinical staff. We worked with NHS Education for Scotland (NES) to produce an online training module, which clinical staff across Scotland have accessed over 2,000 times so far. We hosted networking events for staff to share their successes, challenges and learning.
Evidencing the impact
Our work in partnership with NHS boards to improve the recognition of and response to deteriorating patients has contributed to a 27% reduction in the cardiac arrest rate across 16 reporting hospitals during March 2013 to March 2019. On average, there are 17 fewer people per month suffering this harmful experience in acute hospitals in Scotland.
The early recognition and response approach has helped staff in NHS boards to have conversations to support person centred care planning based on an individual’s clinical condition. This has been central to improving better outcomes for people in NHS Scotland.
NHS Fife employed an innovative, local campaign approach called “Know the Score”. This platform pulled together all the elements to recognise and respond to deteriorating patients. They made sure they had a robust system in place to review all cardiac arrests and review the learning with individual teams. The Fife team held daily hospital safety huddles to communicate about all deteriorating patients and their treatment plans. This approach contributed to their 48% reduction in cardiac arrest rates.