Cardiac Arrests: A Comparison Sutdy

Cardiac Arrests: A Comparison Sutdy of Hospital With and Hospital Without Critical Care Team

It has been reported in recent studies that medical emergency teams and specifically critical care teams bring about a reduction in the incidence of mortality due to cardiac arrest. (Smith & Nolan, 2002; Buist, Harrison, Abaloz, & Dyke, 2007; Chrysochoou and Gunn, 2006)

The research proposed herein has as its aim the auditing of two hospitals and specifically one hospital that has a critical care outreach team and another hospital that does not have a critical care outreach team and to compare the reason why and number of cardiac arrests occurring in each hospital over the period of one months time.

The significance of the study proposed herein is the knowledge that will be gained in regards to the necessity and benefits of a critical care outreach team in the event of cardiac arrests of patients and their survival rates.

BACKGROUND

There are recent studies that report that the use of a critical care outreach team brings about a reduction in the incidence of cardiac arrests as well as the mortality of patients admitted to the hospital for cardiac arrest. There are however, studies that report findings contrary results. The work of Piquette and Fowler (2005) reports that the goals of the medical emergency team (MET) are "...the early identification and treatment of potentially unstable conditions among in-hospital patients so that unexpected cardiac arrests, deaths, and unplanned intensive care unit (ICU) admissions may be prevented. The team usually consists of a physician, nurse and respiratory therapist skilled at critical and emergency care. A number of studies have shown an association between MET system implementation and decreased morbidity and mortality, but those studies have been of limited size and methodological rigor." p.1

RESEARCH QUESTIONS

The research questions that this study seeks to answer include the questions stated as follows:

(1) What benefits do patients who are experiencing cardiac arrest derive from a critical care outreach team for the hospital in which they seek care?

(2) Is the survival rate higher following cardiac arrests in hospitals that feature critical care outreach teams?

LITERATURE REVIEW

The work of Ball, Kirkby and Williams (2003) entitled: "Effect of the Critical Care Outreach Team on Patient Survival to Discharge from Hospital and Readmission to Critical Care: Non-Randomized Population-Based Study" reports a study for the purpose of determining the "...effect of the critical care outreach team on patient survival to discharge from hospital after discharge from critical care and readmission to critical care." Participants in the study were patients who were discharged from the critical care unit following their first or only admission for the study periods of February 26, 2000 through February 25, 2001 and February 26, 2001 through February 25, 2002. The primary outcomes measures in the study were "survival to discharge from hospital after discharge from critical care and readmission to critical care." (Ball, Kirkby and Williams, 2003) Findings of the study report that "...introduction of a critical care outreach team improved survival to discharge from hospital after discharge from critical care by 6.8% (risk ratio 1.08). Readmission to critical care decreased by 6.4% (0.48)." (Ball, Kirkby and Williams, 2003)

The work of Simone, et al. (2007) entitled: "The Introduction of a Critical Care Rapid Response Team in a Canadian Community Hospital" reports a study with the purpose of the use of a critical care outreach team "...consisting of a critical care nurse, respiratory therapist and physician." It is reported that the team led by a nurse responds to calls from the inpatient wards. Next a full patient assessment is completed in addition to communication with the physician and if appropriate bedside teaching with the front-line workers in the hospital ward. Study results reported are as follows:

"From November 2006 to January 2007 a total of 168 patients were seen. All ICU discharges (n_112) were followed and new consults (n_56) were seen by the Outreach Team. Of the new consults 23 were transferred to ICU and 43 remained on the wards. The transfer of these patients was greatly facilitated and the inpatient ward staff was greatly satisfied with the interaction with the Outreach Team. Bedside education, expert resources and better patient-family communication were the most valued features of the team when the in-patient ward staff was surveyed. We noted a tremendous increase in the accessibility of the ICU to the hospital population. We did not, however, notice a decrease in the number of cardiac arrests in the hospital." (Simone, et al., 2007)

It was reported in the work entitled: "Pilot Project at TGH Shows that Critical Care Response Teams Can Significantly Reduce Cardiac and Respiratory Arrests and Hospital Deaths" in 2007 that data gathered between May 2005 and May 2006 "on the impact of the critical care response teams on 342 patients in Toronto General Hospital, University Health Network (UHN) showed that there was a seven percent reduction in heart attacks and a 25% reduction in respiratory arrests (when patients stop breathing and need mechanical assistance to breathe)." (University Health Network, 2007) This equals approximately 80 saved lives in one years' time. Data is also stated to have shown that "...after the response teams intervened, 71% of patients were able to remain on the ward, and 21% were transferred to the ICU. Others were transferred to units with more intense care that the wards." (University Health Network, 2007)

The work of Baxter (nd) entitled: "Critical Care Outreach at the Ottawa Hospital" reports that critical care outreach enables:

(1) Earlier recognition of patients at risk of significant deterioration and better use of vital signs; and (2) Early aggressive and adequate resuscitation by experienced personnel. (Baxter, nd)

This has led to:

(1) Prevention of physiological deterioration; and (2) Improved outcomes for patients. (Baxter, nd)

Resulting as well were the following benefits: