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Clemente Vivancos Á, León Castelao E, Castellanos Ortega Á, Bodi Saera M, Gordo Vidal F, Martin Delgado MC, Jorge-Soto C, Fernandez Mendez F, Igeño Cano JC, Trenado Alvarez J, Caballero Lopez J, Parraga Ramirez MJ. National Survey: How Do We Approach the Patient at Risk of Clinical Deterioration outside the ICU in the Spanish Context? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12627. [PMID: 36231926 PMCID: PMC9565925 DOI: 10.3390/ijerph191912627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Anticipating and avoiding preventable intrahospital cardiac arrest and clinical deterioration are important priorities for international healthcare systems and institutions. One of the internationally followed strategies to improve this matter is the introduction of the Rapid Response Systems (RRS). Although there is vast evidence from the international community, the evidence reported in a Spanish context is scarce. METHODS A nationwide cross-sectional research consisting of a voluntary 31-question online survey was performed. The Spanish Society of Intensive, Critical and Coronary Care Medicine (SEMICYUC) supported the research. RESULTS We received 62 fully completed surveys distributed within 13 of the 17 regions and two autonomous cities of Spain. Thirty-two of the participants had an established Rapid Response Team (RRT). Common frequency on measuring vital signs was at least once per shift but other frequencies were contemplated (48.4%), usually based on professional criteria (69.4%), as only 12 (19.4%) centers used Early Warning Scores (EWS) or automated alarms on abnormal parameters. In the sample, doctors, nurses (55%), and other healthcare professionals (39%) could activate the RRT via telephone, but only 11.3% of the sample enacted this at early signs of deterioration. The responders on the RRT are the Intensive Care Unit (ICU), doctors, and nurses, who are available 24/7 most of the time. Concerning the education and training of general ward staff and RRT members, this varies from basic to advanced and specific-specialized level, simulating a growing educational methodology among participants. A great number of participants have emergency resuscitation equipment (drugs, airway adjuncts, and defibrillators) in their general wards. In terms of quality improvement, only half of the sample registered RRT activity indicators. In terms of the use of communication and teamwork techniques, the most used is clinical debriefing in 29 centers. CONCLUSIONS In terms of the concept of RRS, we found in our context that we are in the early stages of the establishment process, as it is not yet a generalized concept in most of our hospitals. The centers that have it are in still in the process of maturing the system and adapting themselves to our context.
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Affiliation(s)
- Álvaro Clemente Vivancos
- Health Sciences Doctoral Program, Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain
- Advanced Nursing Practice, Hospital del Mar, 08003 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Esther León Castelao
- Simulation Laboratory, School of Medicine and Health Sciences, 08036 Barcelona, Spain
- Clinical Simulation Lab, University of Barcelona, 08036 Barcelona, Spain
| | - Álvaro Castellanos Ortega
- Intensive Care Unit Medical Director, University Hospital La Fe, 46026 Valencia, Spain
- Associate Lecturer, University of Valencia, 46010 Valencia, Spain
| | - Maria Bodi Saera
- Intensive Care Unit, University Hospital Joan XIII, 43005 Tarragona, Spain
- Pere I Virgili Health Research Institute, Rovira I Virgili University, 43003 Tarragona, Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIEBERES), Carlos III Health Institute, 28029 Madrid, Spain
| | - Federico Gordo Vidal
- Intensive Care Unit, University Hospital of Henares, 28822 Madrid, Spain
- Critical Pathology Research Group, Francisco de Vitoria University, 28223 Madrid, Spain
| | - Maria Cruz Martin Delgado
- Intensive Care Unit, Hospital 12th of October, 28041 Madrid, Spain
- Facultad de Medicina, Francisco de Vitoria University, 28223 Madrid, Spain
| | - Cristina Jorge-Soto
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidad de Santiago de Compostela, 15705 Galicia, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, 15705 Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, 15705 Santiago de Compostela, Spain
| | - Felipe Fernandez Mendez
- School of Nursing, Universidade de Vigo, 36310 Pontevedra, Spain
- REMOSS Research Group, Universidade de Vigo, 36310 Pontevedra, Spain
| | | | - Josep Trenado Alvarez
- Intensive Care and High Dependency Unit, Mutua Terrassa Hospital, 08221 Terrasa, Spain
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Jesus Caballero Lopez
- Intensive Care Unit, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
- IRBLleida, 25198 Lleida, Spain
| | - Manuel Jose Parraga Ramirez
- Intensive Care Unit, JM Morales Meseguer, 30008 Murcia, Spain
- Simulation and Clinical Skills Director, UCAM, 30107 Murcia, Spain
- Medical Degree Direction Team, UCAM, 30107 Murcia, Spain
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Schluep M, Endeman H, Gravesteijn BY, Kuijs C, Blans MJ, van den Bogaard B, Van Gemert AWMMK, Hukshorn CJ, van der Meer BJM, Knook AHM, van Melsen T, Peters R, Simons KS, Spijkers G, Vermeijden JW, Wils EJ, Stolker RJ, Hoeks SE. In-depth assessment of health-related quality of life after in-hospital cardiac arrest. J Crit Care 2021; 68:22-30. [PMID: 34856490 DOI: 10.1016/j.jcrc.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Evidence on physical and psychological well-being of in-hospital cardiac arrest (IHCA) survivors is scarce. The aim of this study is to describe long-term health-related quality of life (HRQoL), functional independence and psychological distress 3 and 12 months post-IHCA. METHODS A multicenter prospective cohort study in 25 hospitals between January 2017 - May 2018. Adult IHCA survivors were included. HRQoL (EQ-5D-5L, SF-12), psychological distress (HADS, CSI) and functional independence (mRS) were assessed at 3 and 12 months post-IHCA. RESULTS At 3-month follow-up 136 of 212 survivors responded to the questionnaire and at 12 months 110 of 198 responded. The median (IQR) EQ-utility Index score was 0.77 (0.65-0.87) at 3 months and 0.81 (0.70-0.91) at 12 months. At 3 months, patients reported a median SF-12 (IQR) physical component scale (PCS) of 38.9 (32.8-46.5) and mental component scale (MCS) of 43.5 (34.0-39.7) and at 12 months a PCS of 43.1 (34.6-52.3) and MCS 46.9 (38.5-54.5). DISCUSSION Using various tools most IHCA survivors report an acceptable HRQoL and a substantial part experiences lower HRQoL compared to population norms. Our data suggest that younger (male) patients and those with poor functional status prior to admission are at highest risk of impaired HRQoL.
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Affiliation(s)
- M Schluep
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - H Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B Y Gravesteijn
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - C Kuijs
- Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands; Resuscitation Committee, Maasstad Hospital, Rotterdam, the Netherlands
| | - M J Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - B van den Bogaard
- Department of Intensive Care Medicine, OLVG, Amsterdam, the Netherlands
| | | | - C J Hukshorn
- Department of Intensive Care Medicine, Isala Hospital, Zwolle, the Netherlands
| | | | - A H M Knook
- Department of Intensive Care Medicine, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - T van Melsen
- Department of Intensive Care Medicine, Haaglanden Medisch Centrum, The Hague, the Netherlands
| | - R Peters
- Department of Cardiology, Tergooi Hospital, Hilversum, the Netherlands
| | - K S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - G Spijkers
- Department of Hospital Medicine, ZorgSaam Zeeuws-Vlaanderen, Terneuzen, the Netherlands
| | - J W Vermeijden
- Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - E-J Wils
- Department of Intensive Care Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - R J Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S E Hoeks
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Gravesteijn BY, Schluep M, Lingsma HF, Stolker RJ, Endeman H, Hoeks SE. Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study. Crit Care 2021; 25:329. [PMID: 34507601 PMCID: PMC8431928 DOI: 10.1186/s13054-021-03754-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. METHODS A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. RESULTS After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). CONCLUSION In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.
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Affiliation(s)
- B Y Gravesteijn
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA, Rotterdam, The Netherlands.
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M Schluep
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H F Lingsma
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA, Rotterdam, The Netherlands
| | - R J Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Endeman
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S E Hoeks
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Schluep M, Hoeks SE, Blans M, van den Bogaard B, Koopman-van Gemert A, Kuijs C, Hukshorn C, van der Meer N, Knook M, van Melsen T, Peters R, Perik P, Simons K, Spijkers G, Vermeijden W, Wils EJ, Robert Jan Stolker RJ, Rik Endeman H. Long-term survival and health-related quality of life after in-hospital cardiac arrest. Resuscitation 2021; 167:297-306. [PMID: 34271127 DOI: 10.1016/j.resuscitation.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In-hospital cardiac arrest (IHCA) is an adverse event associated with high mortality. Because of the impact of IHCA more data is needed on incidence, outcomes and associated factors that are present prior to cardiac arrest. The aim was to assess one-year survival, patient-centred outcomes after IHCA and their associated pre-arrest factors. METHODS A multicentre prospective cohort study in 25 hospitals between January 1st 2017 and May 31st 2018. Patients ≥ 18 years receiving cardiopulmonary resuscitation (CPR) for IHCA were included. Data were collected using Utstein and COSCA-criteria, supplemented by pre-arrest Modified Rankin Scale (MRS, functional status) and morbidity through the Charlson Comorbidity Index (CCI). Main outcomes were survival, health-related quality of life (HRQoL, EuroQoL) and functional status (MRS) after one-year. RESULTS A total of 713 patients were included, 64.5% was male, median age was 63 years (IQR 52-72) and 72.8% had a non-shockable rhythm, 394 (55.3%) achieved ROSC, 231 (32.4%) survived to hospital discharge and 198 (27.8%) survived one year after cardiac arrest. Higher pre-arrest MRS, age and CCI were associated with mortality. At one year, patients rated HRQoL 72/100 points on the EQ-VAS and 69.7% was functionally independent. CONCLUSION One-year survival after IHCA in this study is 27.8%, which is relatively high compared to previous studies. Survival is associated with a patient's pre-arrest functional status and morbidity. HRQoL appears acceptable, however functional rehabilitation warrants attention. These findings provide a comprehensive insight in in-hospital cardiac arrest prognosis.
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Affiliation(s)
- Marc Schluep
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Intensive Care Medicine, OLVG, Amsterdam, the Netherlands.
| | - Sanne Elisabeth Hoeks
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Michiel Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | | | | | - Cees Kuijs
- Resuscitation Committee, Maasstad Hospital, Rotterdam, the Netherlands
| | - Chris Hukshorn
- Department of Intensive Care Medicine, Isala Hospital, Zwolle, the Netherlands
| | | | - Marco Knook
- Department of Intensive Care Medicine, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Trudy van Melsen
- Department of Intensive Care Medicine, Haaglanden Medisch Centrum, The Hague, the Netherlands
| | - René Peters
- Department of Cardiology, Tergooi Hospital, Hilversum, the Netherlands
| | - Patrick Perik
- Department of Cardiology, Deventer Hospital, Deventer, the Netherlands
| | - Koen Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Gerben Spijkers
- Department of Hospital Medicine, ZorgSaam Zeeuws-Vlaanderen, Terneuzen, the Netherlands
| | - Wytze Vermeijden
- Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - R J Robert Jan Stolker
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - H Rik Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
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