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No increase in deaths from cardiac arrests at the weekend, says study

This study follows on from work previous work suggesting that there is a ‘weekend effect’.

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Cardiac Arrest AED
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No difference in survival for those admitted on the weekend.

People admitted to NHS hospitals with a cardiac arrest over the weekend do not face a higher risk of dying compared to those admitted during the week, according to a new study.

The research led by Dr Rahul Potluri, founder of the ACALM study unit at Aston University, investigated 4,803 patients admitted to hospital with a cardiac arrest.

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The team looked at five-year survival for people suffering a cardiac arrest and being treated in an NHS hospital. They found that there were no differences in survival for those admitted on the weekend.

This study follows on from work previous work suggesting that there is a ‘weekend effect’ in people going to hospital with heart failure or atrial fibrillation – the most common type of abnormal heart rhythm.

Cardiac arrest teams working 24 hours a day, all year round, could be responsible for the same standard of care and outcome of those suffering a cardiac arrest whether they are being treated in the week or at the weekend.

The same chance of survival.

Dr Rahul Potluri, Clinical Lecturer in Cardiology at Aston Medical School, said: “No matter which day of the week someone goes to hospital with a cardiac arrest, they have the same chance of survival, and that should be hugely reassuring to the public.

“By no means is the weekend effect a blanket phenomenon. We know that it does exist for people affected by other heart conditions. It’s therefore important to tease out who is affected by the weekend effect through research in order to ensure that specialist healthcare services are delivered when and where they are needed most.”

Professor Metin Avkiran, Associate Medical Director at the British Heart Foundation said:  “This is a success story, and shows the life saving importance of specialist teams working in the NHS. A cardiac arrest is a medical emergency and statistics show that for every minute that passes without CPR and defibrillation, a person’s chance of survival decreases by around 10 per cent.

“If you see someone who has suddenly collapsed and is unresponsive, it is vital that you call 999 and start administering CPR immediately to increase their chances of survival. When the emergency services arrive, you can rest assured that you’ve done your bit and the specialists are ready and waiting to take over.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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