Recent Submissions

  • A 6-Year thematic review of reported incidents associated with cardiopulmonary resuscitation calls in a United Kingdom hospital

    Beed, Martin; Hussein, Sumera; Woodier, Nick; Fletcher, Cathie (2022)
    BACKGROUND: Critical incident reporting can be applied to cardiopulmonary resuscitation (CPR) events as a means of reducing further occurrences. We hypothesized that local CPR-related events might follow patterns only seen after a long period of analysis. DESIGN: We reviewed 6 years of local incidents associated with cardiac arrest calls. The following search terms were used to identify actual or potential resuscitation events: "resuscitation," "cardio-pulmonary," "CPR," "arrest," "heart attack," "DNR," "DNAR," "DNACPR," "Crash," "2222." All identified incidents were independently reviewed and categorized, looking for identifiable patterns. SETTING: Nottingham University Hospitals is a large UK tertiary referral teaching hospital. RESULTS: A total of 1017 reports were identified, relating to 1069 categorizable incidents. During the same time, there were approximately 1350 cardiac arrest calls, although it should be noted that many arrest-related incidents were not associated with cardiac arrest call (e.g., failure to have the correct equipment available in the event of a cardiac arrest). Incidents could be broadly classified into 10 thematic areas: no identifiable incident (n = 189; 18%), failure to rescue (n = 133; 12%), staffing concerns (n = 134; 13%), equipment/drug concerns (n = 133; 12%), communication issues (n = 122; 10%), do-not-attempt-CPR decisions (n = 101; 9%), appropriateness of patient location or transfer (n = 96; 9%), concerns that the arrest may have been iatrogenic (n = 76; 7%), patient or staff injury (n = 43; 4%), and miscellaneous (n = 52; 5%). Specific patterns of events were seen within each category. CONCLUSIONS: By reviewing incidents, we were able to identify patterns only noticeable over a long time frame, which may be amenable to intervention. Our findings may be generalizable to other centers or encourage others to undertake this exercise themselves. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
  • 'MORAL balance' decision-making in critical care

    Harvey, Daniel J.; Gardiner, Dale C. (2019)
  • Emergency department use and length of stay by younger and older adults: Nottingham cohort study in the emergency department (NOCED).

    Ogliari, Giulia; Coffey, Frank; Keillor, Lisa; Aw, Darren; Azad, Michael Yakoub; Allaboudy, Mohammad; Ali, Aamer; Jenkinson, Tom; Christopher, Mike; Szychowski-Nowak, Kosma; et al. (Springer, 2022)
    BACKGROUND: Younger and older adults attending the Emergency Department (ED) are a heterogeneous population. Longer length of ED stay is associated with adverse outcomes and may vary by age. AIMS: To evaluate the associations between age and (1) clinical characteristics and (2) length of ED stay among adults attending ED. METHODS: The NOttingham Cohort study in the Emergency Department (NOCED)-a retrospective cohort study-comprises new consecutive ED attendances by adults >= 18 years, at a secondary/tertiary care hospital, in 2019. Length of ED stay was dichotomised as = 4 h. The associations between age and length of ED stay were analysed by binary logistic regression and adjusted for socio-demographic and clinical factors including triage acuity. RESULTS: 146,636 attendances were analysed; 75,636 (51.6%) resulted in a length of ED stay >= 4 h. Attendances of adults aged 65 to 74 years, 75 to 84 years and >= 85 years, respectively, had an increased risk (odds ratio (95% confidence interval) of length of ED stay >= 4 h of 1.52 (1.45-1.58), 1.65 (1.58-1.72), and 1.84 (1.75-1.93), compared to those of adults 18 to 64 years (all p = 4 h, with the oldest old having the highest risk. ED target times should take into account age of attendees. Copyright © 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.