PURPOSE: Patients admitted to hospital due to cardiopulmonary disease are at highest risk of in-hospital cardiac arrest. In-hospital cardiac arrest is often preceded by a period of clinical deterioration. Early detection and effective intervention might prevent the physiological instability from progressing to cardiac arrest. The purpose of this study is to reduce the incidence of in-hospital cardiac arrest in a cardiopulmonary ward by implementation of clinical alert system bundle, which is based on the concept of rapid response system.
METHODS: The study was carried out in a 51-bed cardiopulmonary ward in a 1212-bed medical center in southern Taiwan. Eighty percent of patients are admitted from emergency department or transferred from intensive care units. The process of implementing clinical alert system bundle started in 2008, and therefore we compared the incidence of in-hospital cardiac arrest before (2007) and after (2009- April 2010) the bundle implementation. The implementation of clinical alert system bundle included the following main points: (1)A set of criteria to trigger clinical alert system. The criteria were defined in order to identify patients at high risk of clinical instability. (2)Direct contact with senior residents or staffs by nurses. Once the system was triggered, the nurses were requested to directly contact senior residents or the staffs who were in charge of that patient if current management were considered suboptimal.(3)Enhanced role of the senior nurses. Senior nurses were assigned the role of the intensive care liaison nurses if the system was activated. (4)Reports of at-risk patients in the nursing shift reports. (5)Case-oriented simulation practice and discussion weekly in routine nursing meetings.
RESULTS: The incidence of in-hospital cardiac arrest decreased significantly (19 cardiac arrests/3602 admissions (0.50%) vs. 13/5183(0.30%), p=0.034) after complete implementation of the bundle.
CONCLUSION: The incidence of in-hospital cardiac arrest decreased significantly (19 cardiac arrests/3602 admissions (0.50%) vs. 13/5183(0.30%), p=0.034) after implementation of the bundle.
CLINICAL IMPLICATIONS: The clinical alert system bundle can be considered an alternative to rapid response team, especially when the health care resources are limited.
DISCLOSURE: Hsiao-Yen Hsieh, No Financial Disclosure Information; No Product/Research Disclosure Information