Title: Avoidable mortality from in-hospital cardiac arrest: Have interventions aimed at recognising and rescuing deteriorating patients made an impact on incidence and outcomes?
Funder: Department of Health (England)

Abstract: Background: IHCA is an important cause of avoidable mortality. The National Cardiac Arrest Audit (NCAA) which collects data on arrest rates and survival rates from 60% of acute hospitals in England has found 4 fold variation in both of these measures. Key to reducing arrest rates and subsequent death is the identification of patients at risk of deterioration and responding promptly. A range of targetted interventions have been introduced but recent research indicates that implementation varies between hospitals. These differences are likely to contribute to the observed variation in the case-mix adjusted incidence and outcome of cardiac arrests between and within hospitals over time.Aim: To determine how the implementation of interventions and packages of interventions aimed at identification and management of deteriorating patients is associated with the incidence of in-hospital cardiac arrest (IHCA) and outcomes.Research Plan: A non-randomised study which exploits existing variation both in healthcare interventions and in outcomes (a natural experiment). The study involves evaluation of implementation fidelity that is the assessment of differences in the extent to which different interventions have been implemented and the moderating impact of different contexts. A typology of interventions will be developed based on a systematic review of the literature on the effectiveness of interventions including identifying key components processes and contextual factors and qualitative interviews in 20 acute Trusts. The typology will form the basis of a survey of the principal interventions and their contexts in all English hospitals taking part in the NCAA. Cross-sectional before:after/time series and difference-in-difference approaches will be used to assess associations between interventions and IHCA incidence and outcomes. Research Team: The team includes members with experience of conducting health services organisational and clinical research into the effectiveness of care for critically ill patients both in ward and ITU settings. The team has a balance of academicsclinicians and managers whose roles span the range of acute care settings and patient representatives. Two members have experience of leading a large collaboration across 13 Trusts aimed at reducing avoidable mortality through better management of the deteriorating patient. The research team have links with acute hospitals ICUs Critical Care Outreach Teams (CCOTs) and resuscitation teams throughout England which will facilitate collaboration.Research Environment: LSHTM has a reputation for undertaking high quality health services research and delivering on time and within budget. Anticipated Outputs Outcomes and Impact: The study will produce a rigorous review of the scientific evidence of the effectiveness of interventions aimed at the deteriorating patient a service evaluation of existing interventions in England and an evaluation of associations between interventions and outcomes. This will inform clinicians and hospital managers responsible for service redesign aimed at reducing avoidable mortality. The findings will also inform future research and enable assessment of the value of IHCA incidence as a potential measure of quality of care. Patient and Public Involvement: Patient representatives will be included in the study’s Steering Group and contribute to study design on-going oversight and dissemination.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: CARDIOVASCULAR