Articles: hospitals.
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Review Comparative Study
In-hospital cardiopulmonary resuscitation. Survival in 1 hospital and literature review.
Cardiopulmonary resuscitation (CPR) has been used extensively in the hospital setting since its introduction over 3 decades ago. We reviewed the CPR records at 1 hospital during a 2-year period and the results from 113 published reports of inpatient CPR with a total patient population of 26,095. We compared the survival rates of patients following CPR and the pre-arrest and intra-arrest factors related to survival. ⋯ Patient's location was related to outcome, with emergency room and coronary care unit patients more likely to survive than intensive care unit and general ward patients. Other factors related to better survival rates were respiratory arrest, witnessed arrest, absence of comorbidity, and short duration of CPR. Knowledge of the likelihood of survival following CPR for subgroups of the hospital population based on pre-arrest and intra-arrest factors can help patients, their families, and their physicians decide, with compassion and conviction, in what situations CPR should be administered.
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The development of the AHA Guidelines for CPR and ECC and the AARC RACH Clinical Practice Guideline should both be instrumental in improving the performance of RCPs on in-hospital resuscitation teams. The AARC and AHA are assuming important leadership roles in this movement by publishing CPGs for CPR and ECC. RCPs with ACLS training are in a prime position to assume more responsibility on resuscitation teams within acute care facilities. ⋯ Successful CPR outcome should be carefully defined using the patient's disease category. Each patient should be individually evaluated for DNR orders. As suggested by Schwenzer, "Patients' perception of their quality of life before and after CPR should guide their and our decisions." However, we must all accept the responsibility for defining the limitations of medical technology and try to determine when CPR is futile.
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In response to concerns about the number of interstate and overseas visitors using Queensland hospital services, the present study examined a sample of 1,295 hospital records to determine the proportion of patients who were incorrectly identified as Queensland residents. Across six hospitals the overall detection rate was 4.6%. Rates varied between hospitals, with the highest detection recorded for Goondiwindi near the Queensland/New South Wales border; and the lowest for Prince Charles in Brisbane. ⋯ In particular, Goondiwindi and the Gold Coast had substantially higher detection rates for the Christmas holiday period (December-January) than for the mid-year period (June-August). These findings are discussed in terms of their implications for hospital services, especially lost revenue and increased patient load. Health information managers are identified as a key group for addressing some of the current problems in this area.
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Review Case Reports
Frequency of anesthetic cardiac arrest and death in the operating room at a single general hospital over a 30-year period.
To determine the anesthetic cardiac arrest (CA) and death rates in the operating room (OR) and to determine whether anesthetic CA and death are preventable. ⋯ The results of 30 years' experience do not support the hypothesis that all anesthetic CAs and deaths are preventable. However, careful clinical management can reduce their frequency to a level lower than those reported in the referenced literature.