The deaths of around one in five patients who suffered a cardiac arrest after they were admitted to hospital may have been prevented with earlier treatment, according to a new report.
A study of 550 patients across England, Wales and Northern Ireland has revealed that medical staff failed to heed warning signs that 99 patients may suffer a cardiac arrest. The patients were subsequently resuscitated, but died afterwards, despite little indication that they were dying anyway. The report's author, Dr George Findlay, of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), said that the deaths could potentially have been avoided - had staff carried out the correct procedures.
In more than 13 per cent of cases, the report found, elderly and dying patients were needlessly given resuscitation when it was clear they were going to die - exacerbating their pain at the end of their lives.
"That is applying intervention inappropriately," Dr Findlay told Channel 4 News.
"We need to think about whether CPR [cardio pulmonary resuscitation] is going to provide any benefit. If it isn't, it is an undignified and painful process at the end of life."
The report found that the primary reasons for the incorrect use of resuscitation or a failure to detect an early risk of cardiac arrest for patients was cultural as well as systemic. - Dr George Findlay, NCEPOD
"We need to think about whether CPR [cardio pulmonary resuscitation] is going to provide any benefit. If it isn't, it is an undignified and painful process at the end of life.
In many cases, Dr Findlay said, the patient was assessed by a junior doctor who failed to inform a senior doctor of the patient's needs at the door of the hospital.
The report found that nearly one in two patients were poorly assessed on admission, and that in around half of cases, warning signs of cardiac arrest were not acted upon by staff.
In other cases, there is "also a cultural problem. Currently, the default position is that if you have a cardiac arrest, CPR will happen. But we need to ask ourselves: is CPR beneficial for this patient? For too long, doctors have been poor at recognising the limitations of CPR in patients who are dying. We need to manage death better."
The data was collected as a representative sample over two weeks. Researchers spent another year analysing and reviewing it.
Dr Findlay added that although the Royal College of Physicians and the Society of Acute Medicine have been promoting the use of more senior doctors and consultants at the door of the hospital to improve assessment, further work needs to be done.
However, he also said that it is important to stress that many patients who enter hospital and suffer heart attacks are treated correctly and can return home when well enough.
NCEOPD chairman Bertie Leigh said that he hoped the report would act as a wake-up call to the NHS. He said: "In nearly half of all the cases we reviewed there was a failure to forumlate an appropriate care plan on admmission, and a failure, often over several days, to find out what the patient's wishes were - and to carry them out.
"We are at a crossroads. All of us need to recognise and accept the limits of what can be achieved in medicine to the benefit of the patient, and a 'ceiling of treatment' described and agree with the patient whereever possible."
29 February 2012
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