Clinical Alert System to Reduce Hospital Unexpected Cardiac Arrest Event

Friday, 28 July 2017

Chi-Hsuan Asphodel Yang, PhD
Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
Lee-Ling Huang, MSN
Department of Nursing, Cheng-Ching General Hospital HOSPITAL, Taichung, Taiwan, Taichung, Taiwan

Purpose:  The purpose of the paper was to determine whether clinical alert system led by nurses prompted by clinical instability in a patient could reduce the incidence of unexpected cardiac arrest in hospital.

Methods: A retrospective analysis of data extracted from medical records was performed to compare the incidence of UAC before and after the implantation of the CAS. The study was conducted at a 350-bed teaching hospital in central Taiwan area. Medical records of all adult patients admitted to the non-ICU wards of the hospital from January 1, 2010 to December 31, 2015 were reviewed. Patients who had signed do-not resuscitate order were excluded. We measure the incidence of unexpected cardiac arrests that occurred outside of the intensive care unit and occurred over the study period.

Results: There were 557 CAS calls during the study period. In the 36 months before the CAS began, the overall unexpected cardiac arrest was0.020% per month. In the subsequent 36 months, that UAC rate was 0.021% per month. A slightly increase of UAC incidence was noted. A Bai-Perron method was used to test if there was any structure break appeared in the UAC rate of the 72 months. The analysis of Bai-Perron method identified the structural break date to be the 4th month of 2015 (F = 26.1732, p < .01), that after April 2015, the trend of UCA rate was shifted to a lower rate. In addition, the result of a order logistic regression showed three possible determinants of clinical outcomes after CAS; they were comorbidity ≧4 (p = .0054); presentation of neurological sign and symptom (p = .0000) and presentation of cardio-pulmonary sign and symptom (p = .0000).

Conclusion: While it may take up to 16 months to see the positive effect, the deployment of a clinical alert system may help in early recognition and response to patients’ deterioration to further prevent UCA. Nurses should familiarize with the important clinical alerting sign and symptoms of patients; so that nurse could initiate early response to patients’ deterioration and could further help prevent UCA.