Reduction of in-hospital cardiac arrest rates in intensive care-equipped New South Wales hospitals in association with implementation of Between the Flags rapid response system

Deepak Bhonagiri; Harvey Lander; Malcolm Green; Lahn Straney; Daryl Jones; David Pilcher

doi:10.1111/imj.14812

Reduction of in-hospital cardiac arrest rates in intensive care-equipped New South Wales hospitals in association with implementation of Between the Flags rapid response system

Intern Med J. 2021 Mar;51(3):375-384. doi: 10.1111/imj.14812.

Authors

Deepak Bhonagiri^{1

2

3

4

5

6}, Harvey Lander^{6

7

8}, Malcolm Green^{7

8}, Lahn Straney^{9

10}, Daryl Jones^{9

11

12}, David Pilcher^{9

13

14}

Affiliations

¹ Liverpool Hospital, Sydney, NSW, Australia.
² Campbelltown Hospital, Sydney, NSW, Australia.
³ University of New South Wales, Sydney, NSW, Australia.
⁴ Macquarie University, Sydney, NSW, Australia.
⁵ Western Sydney University, Sydney, NSW, Australia.
⁶ Simpson Centre for Health Services Research, Sydney, NSW, Australia.
⁷ Clinical Excellence Commission, Sydney, NSW, Australia.
⁸ NSW Health, Sydney, New South Wales, Australia.
⁹ Monash University, Melbourne, Vic, Australia.
¹⁰ Australian National University, Melbourne, Vic, Australia.
¹¹ Austin Health, Melbourne, Vic, Australia.
¹² University of Melbourne, Melbourne, Vic, Australia.
¹³ Alfred Health, Melbourne, Vic, Australia.
¹⁴ The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Melbourne, Victoria, Australia.

PMID: 32133760
DOI: 10.1111/imj.14812

Abstract

Background: The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, in response to the death of a young patient, as a system-wide approach for early detection and management of the deteriorating patient in all NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously.

Aim: To assess the impact of 'Between the Flags' (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW, on the incidence of in-hospital cardiac arrests and the incidence and outcome of patients admitted to an ICU following cardiac arrest and rapid response team activation.

Methods: This is a prospective observational study of the BTF registry (August 2010 to June 2016) and the Australian and New Zealand Intensive Care Society Adult Patient Database (January 2008 to December 2016) in 35 New South Wales public hospitals with an ICU. The primary outcome studied was the proportion of in-hospital cardiac arrests. Secondary outcomes included changes in the severity of illness and outcomes of cardiac arrest admissions to the ICU and changes in the volume of rapid response calls.

Results: The cardiac arrest rate per 1000 hospital admissions declined from 0.91 in the implementation period to 0.70. Propensity score analysis showed significant declines in ICU and hospital mortality and length of stay for cardiac arrest patients admitted to the ICU (all P < 0.001).

Conclusions: The BTF programme was associated with a significant reduction in cardiac arrests in hospitals and ICU admissions secondary to cardiac arrests in 35 NSW hospitals with an ICU.

Keywords: cardiac arrest; intensive care; medical emergency team; rapid response team; safety and quality.

Publication types

Observational Study

MeSH terms

Adult
Australia / epidemiology
Critical Care
Heart Arrest* / diagnosis
Heart Arrest* / epidemiology
Heart Arrest* / therapy
Hospital Mortality
Humans
Intensive Care Units
New South Wales / epidemiology
New Zealand / epidemiology