title: Reducing cardiac arrests in the acute admissions unit: a quality improvement journey.
abstract: BACKGROUND
  In 2010, the acute admissions unit (AAU) at Stirling Royal Infirmary had the highest number of cardiac arrests of any ward. A quality improvement project was undertaken to reduce this to <1/1000 admissions by December 2011.
  
  
  METHODS
  In January 2011, based on initial needs assessment, we selected three initiatives to improve cardiac arrest rate: (1) structured response to deteriorating patients; (2) analysis of adverse events; and (3) improved end-of-life decision-making. We performed a failure modes effects analysis to identify reasons for the failure of early recognition and response. Ward staff conducted weekly safety meetings to engage unit staff and promote a safety culture of continuous improvement. Additionally, in July 2011 the unit adopted a ward-based clinical team structure with twice daily consultant ward rounds. Our primary outcome measure, cardiac arrests per 1000 admissions, was measured from January 2011 to August 2012.
  
  
  RESULTS
  Over 17 months, the number of cardiac arrests per 1000 admissions fell from a baseline of 2.8/1000 admissions to 0.8/1000 admissions (71% reduction), referrals to palliative care increased by 22 to 37/1000 admissions per month (68% increase) and the 30-day mortality of patients admitted to the AAU fell from 6.3% to 4.8% (24% relative reduction).
  
  
  CONCLUSIONS
  Through adoption of a shared goal, application of improvement methodology including the model for improvement to test new innovations, and promotion of a safety culture in the AAU, cardiac arrests were successfully reduced to <1/1000 admissions per month with an associated significant fall in mortality. This was achieved with negligible cost.
authors.affiliation: Department of Acute Medicine, Forth Valley Royal Hospital, , Larbert, Stirlingshire, UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Beckett
authors.forename: Monica
authors.initials: M
authors.lastname: Inglis
authors.forename: Sharon
authors.initials: S
authors.lastname: Oswald
authors.forename: Elaine
authors.initials: E
authors.lastname: Thomson
authors.forename: Wilma
authors.initials: W
authors.lastname: Harley
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wilson
authors.forename: Robert C
authors.initials: RC
authors.lastname: Lloyd
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Rooney
mesh_terms: D004636:Emergency Service, Hospital; D004739:England; D006323:Heart Arrest / Q000517:prevention & control*; D006801:Humans; D010343:Patient Admission; D058996:Quality Improvement / Q000458:organization & administration*
keywords: Checklists; Communication; Control charts, run charts; PDSA; Patient safety