Predictors of cardiac arrest in rapid response systems
Halverson, Colleen C.
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Medical errors occur in hospitals throughout the United States (US). These errors result in more than one million injuries and nearly 98,000 deaths annually. The Institute of Medicine report, “To Err is Human”, highlighted the US healthcare system’s failure to do enough to prevent mistakes. Hence, patient safety has become a focal issue. One safety strategy implemented to rescue patients was Rapid Response Systems (RRS). The purpose of this study was to determine whether patient characteristics and RRS interventions could predict the patient outcome of an in-hospital cardiac arrest (IHCA). This observational descriptive study: (a) examined instances in which RRS were activated when triggers (the afferent arm of RRS) were detected for patients in a pre-arrest phase of resuscitation, and (b) reviewed interventions undertaken during the medical emergency team (MET) event (the efferent arm of RRS). Data from the American Heart Association’s “Get with the Guidelines®—Resuscitation” (GWTG®-R) database were used to answer research questions about patient characteristics and RRS interventions associated with IHCA. Binary logistic regression (LR) was conducted to analyze GWTG®-R data that spanned ten years (2005-2015). Data were from 401,651 cases from over 700 hospitals. Using Statistical Program for the Social Sciences (SPSS) software LR resulted with three models, but the effect sizes were small (0.06 to 0.17). The predictor variables with a high probability for IHCA included: Triggers — (a) respiratory, (b) neurologic, (c) medical, and (d) unknown; (e) black race; (f) surgical-cardiac illnesses; (g) 250 to 499 bed hospitals; (h) cardiac drug(s); (i) non-invasive ventilation; (j) invasive ventilation; (k) continuous ECG monitoring; and (l) expert consultations. The study adds knowledge and offers nurses direction as practicing nurses, educators, and researchers to improve patient safety through focus on preventing failure to rescue by using RRS. RRS within GWTG®-R hospitals achieved their purpose to reduce the incidence of IHCA, since only 1% (3,497) of patients who had RRS activated, had IHCA.