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The evaluation of the impact of a world-first state-wide program in reducing cardiac arrests and other adverse events in Emergency Departments in New South Wales

Associate Professor Jack Chen, Institution: University of New South Wales

2015 Partnership Engagement Grant

Years funded: 2016-2021


Up to 400,000 patients die needlessly each year in USA hospitals and many suffer from unexpected cardiac arrests (more than 200,000 per year). The concept of a Rapid Response System (RRS) has been proposed to reduce unexpected cardiac arrests and related mortality. However, there has been no multi-centre study in evaluating the impact of such a system in an Emergency Department (ED) setting. 

The NSW government took a state wide proactive approach to the deteriorating patient by developing standardised policies and guidelines and mandating that every NSW state public hospital implement a RRS. The Clinical Excellence Commission (CEC) implemented a two-tiered RRS under a program called Between the Flags (BTF) with a specific ED module.

In the current study we aim to answer following research questions:
  1. Does the universal implementation of a complex, hospital-wide RRS system across all NSW acute hospitals reduce ED patient unexpected cardiac arrests, hospital mortality and improve other patient safety indicators?
  2. Do such effects differ between hospitals with, and hospitals without, a RRS before, during and after the implementation of such a RRS?
  3. What are the potential barriers and facilitators of implementing such a RRS?

We will adopt a population-based large data linkage study over a three-year period. In order to examine the effectiveness of the implementation of the ED module of the BTF program, the study will analyse changes before, during and after the implementation of the program.  We expect a significant reduction of cardiac arrests and unexpected deaths in the ED as a result of this study.

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