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Biomedical subjects

Robert Crouch

Publications and source records attributed to Robert Crouch.

7 recordsLinked to original sources
PubMed2002

Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital.

AIMS: To determine the incidence of avoidable cardiac arrest among patients who had received resuscitation in a district general hospital. To establish how location and individual or system factors influence avoidable cardiac arrest in order to develop an evidence-based preventive strategy. METHODS: Expert panel review of case-notes from 139 consecutive adult in-hospital cardiac arrests over 1 year. RESULTS: There were 32,348 adult admissions in 1999 with 1,023 deaths. The cardiac arrest team was activated 139 times: 118 were for primary in-hospital cardiac arrest. The cardiac arrest rate excluding 'do not attempt resuscitation' (DNAR) cases was 3.8/1000 admissions. In 88.5% of deaths there was a DNAR policy. Survival to hospital discharge following resuscitation was 14%. Among the 118 cases, the panel unanimously agreed that 61.9% of arrests were potentially avoidable, rising to 68% when emergency department arrests were excluded (66 and 73% for majority opinion). Cardiac arrests were more likely at the weekend than during the week (P = 0.02). The odds of potentially avoidable cardiac arrest was 5.1 times greater for patients in general wards than critical care areas (P < 0.001); patients in critical care areas were more likely to survive (P < 0.001). The odds of potentially avoidable cardiac arrest was 12.6 times greater for patients nursed in a clinical area judged 'inappropriate' for their main complaint (P < 0.002, Fisher's exact test) compared to those nursed in 'appropriate' areas. The panel agreed that 100% of potentially avoidable arrests were judged to have received inadequate prior treatment. Clinical signs of deterioration in the preceding 24 h were not acted upon in 48%, and review was confined to a house officer in 45%. CONCLUSION: The majority of treated in-hospital cardiac arrests are potentially avoidable. Multiple system failures include delays and errors in diagnosis, inadequate interpretation of investigations, incomplete treatment, inexperienced doctors and management in inappropriate clinical areas.

Adult↗
PubMed2002

Developing benchmark inventories to assess the content of telephone consultations in accident and emergency departments: use of the Delphi technique.

The provision of telephone advice to members of the general public from staff based in accident and emergency departments is common practice. However, it is largely conducted on an ad hoc basis without the use of formal guidelines or decision support. The evidence base from which to derive guidelines for the telephone assessment and advice of many common conditions is lacking. This study, using the Delphi technique, was undertaken to develop a number of benchmarks for use as objective measures against which the comprehensiveness of telephone assessments could be tested. Consensus views on the essential and desirable items to be considered for each of 10 presenting complaints was achieved. It is argued that establishing consensus views on clinical topics provides an effective means of developing an evidence base where other sources of evidence are lacking.

Benchmarking↗
PubMedDate not supplied

Physiological observations of patients admitted from A&E.

BACKGROUND: A&E department records were collected over a four-week period for all patients admitted to hospital via A&E. Timing and values of recorded observations were collected, as was the length of time spent in the department. During the study period, 739 patients were admitted. Observation charts were available for 728. Those having some observations within 15 minutes of arrival totalled 640 (88 per cent); 378 (52 per cent) had temperature, heart rate, respiratory rate and blood pressure recorded; and 265 (36 per cent) had repeat observations while waiting for admission. The mean time in the department was three hours 43 minutes. CONCLUSION: Recorded patient observations are carried out in an inconsistent pattern in this A&E department and standards should be set. Patients at risk of deterioration must be identified early. Complete observations should be carried out so that patients with abnormal physiology can be prioritized for treatment and repeated observation can be instituted to monitor response to interventions. Further work is needed to determine variables that provide the best prediction of outcome and whether increasing observation frequency and earlier activation improves outcome.

Blood Pressure Determination↗