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Abstract
Objective To determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls.
Design Prospective observational study.
Setting Three National Health Service acute hospitals in England.
Participants Adult patients sustaining an in-hospital cardiac arrest (CA) or medical emergency (ME) which required activation of the hospital resuscitation team between 1 December 2009 and 30 April 2010.
Main outcome measures Emergency call duration, emergency team dispatch time, diagnostic accuracy of emergency call (sensitivity/specificity), thematic analysis of emergency call, patient outcomes (return of spontaneous circulation and survival to hospital discharge).
Results There were 426 adult resuscitation team activations. There was variability in emergency call duration ranging from 6 to 92 s (median 15 s; IQR 12–19). The sensitivity and specificity of calls for a CA was 91% (86.4–94.6%) and 62% (55.5–68.7%), respectively. Sensitivity did not change with call duration but specificity increased from 38% (25.8–51.0%) for the shortest calls to 82% (69.5–89.6%) for longer calls; p=0.03. The return of spontaneous circulation rate was 38% for calls when the patient was confirmed as in CA upon arrival of the resuscitation team. Survival to hospital discharge rates was higher in patients with shorter call durations (26%) than calls with longer call duration (12%); p=0.028. Five themes emerged identifying reasons for the increased call delay.
Conclusion There is variability in duration and diagnostic accuracy of in-hospital emergency calls. This is associated with delayed activation of the emergency response. The attempt to differentiate between ME and CA is a source of confusion. A single clinical emergency response for CA and ME calls may provide a more focused and timely emergency response.
- In-hospital cardiac arrest
- emergency call duration
- diagnostic accuracy
- healthcare quality improvement
- crew resource management
- graduate medical education
- teamwork
- simulation
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Footnotes
Linked article 000589.
Funding The study forms part of the NIHR RfPB funded CPR quality improvement initiative. This report presents independent research commissioned by the National Institute of Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR of the Department of Health. The study is sponsored by Heart of England NHS Foundation Trust. The study sponsor/funders did not influence study design, collection, analysis and interpretation of data in the writing of the report and in the decision to submit the article for publication. Naheed Akhtar is supported by a Resuscitation Council (UK) PhD Studentship. Gavin Perkins is supported by a DH NIHR Clinician Scientist Award. This project forms part of the NIHR RfPB funded CPR quality improvement initiative.
Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that GDP, RPD, SW and MWC are in receipt of a NIHR RfPB entitled the CPR Quality Improvement Initiative. No authors have financial support for the submitted work; no authors have any relationships with companies that might have an interest in the submitted work in the previous 3 years; their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and no authors have non-financial interests that may be relevant to the submitted work.
Patient consent The ethics committee waived the requirement for patient consent.
Ethics approval Coventry Research Ethics Committee, UK.
Provenance and peer review Not commissioned; externally peer reviewed.