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Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms.

A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation.

There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% (p = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up (p = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up (p = 0.649). However, there was a significant increase in ED boarding rate of 7.7% (p < 0.001) likely due to other hospital factors altering boarding times.

Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.

The purpose of this article is to assess important recent guidelines on resuscitation, published in December 2005.

The guidelines are put into the context of other attempts to standardise CPR practice. An analysis of recent claims and complaints handled by the Medical Protection Society and problems reported to the National Patient Safety Agency, broadens the discussion.

A number of issues of concern arose – the competence of health professionals, recognising the deterioration of patients, communication of Do Not Attempt Resuscitation decisions, and equipment failings. Strengthening training, better monitoring and performance management are important in addressing these issues.

Health professionals have a good opportunity to avail themselves of the new CPR guidelines; it is in the public interest to try and achieve these standards.

The paper highlights the continuing risks in providing substandard resuscitation.

The purpose of this paper is to examine the link between service specialization and operational performance in hospitals. Existing literature has mostly been concerned with the performance effects of operational focus, which can be seen as an extreme form of specialization. It is not clear, however, whether an effect similar to the focus effect can be observed also in cases where specialization takes on less extreme forms. The authors analyze this effect up to and above the effects of volume, learning and patient selection.

Ordinary least squares (OLS) and two‐stage regression models were used to analyze patient data from 142 Austrian hospitals over the 2002‐2006 period. The sample contains 322,193 patient groups (841,687 patient group‐year observations).

The authors find that increased specialization in a service leads to a more efficient provision of this service in terms of shorter length of stay. The analysis shows that this effect holds even after controlling for volume, learning, and patient selection effects. The authors suggest that the pure specialization effect is due to the increased administrative and medical attention that is given to a service when the relative importance of that service increases.

The paper's results indicate hospital managers should pay attention to the impact of specialization when making service‐mix decisions. If two services have the same or a similar level of operational performance, then this does not mean that hospital managers should be indifferent as to the relative volume of these services.

The paper provides additional insights into the impact of service‐level specialization not examined in prior literature.

The purpose of this paper is to re-conceptualise the hot debrief process after cardiac arrest as a collaborative and distributed process across the multi-disciplinary team. There are multiple benefits to hot debriefs but there are also barriers to its implementation. Facilitating the hot debrief discussion usually falls within the remit of the physician; however, the American Heart Association suggests “a facilitator, typically a health-care professional, leads a discussion focused on identifying ways to improve performance”. Empowering nurses through a distributed leadership approach supports the wider health-care team involvement and facilitation of the hot debrief process, while reducing the cognitive burden of the lead physician.

A mixed-method approach was taken to evaluate the experiences of staff in the Emergency Department (ED) to identify their experiences of hot debrief after cardiac arrest. There had been some staff dissatisfaction with the process with reports of negative experiences of unresolved issues after cardiac arrest. An audit identified zero hot debriefs occurring in 2019. A quality Improvement project (Model for Healthcare Improvement) used four plan do study act cycles from March 2020 to September 2021, using two questionnaires and semi-structured interviews to engage the team in the design and implementation of a hot debrief tool, using a distributed leadership approach.

The first survey (n = 78) provided a consensus to develop a hot debrief in the ED (84% in the ED; 85% in intensive care unit (ICU); and 92% from Acute Medicine). Three months after implementation of the hot debrief tool, 5 out of 12 cardiac arrests had a hot debrief, an increase of 42% in hot debriefs from a baseline of 0%. The hot debrief started to become embedded in the ED; however, six months on, there were still inconsistencies with implementation and barriers remained. Findings from the second survey (n = 58) suggest that doctors may not be convinced of the benefits of the hot debrief process, particularly its benefits to improve team performance and nurses appear more invested in hot debriefs when compared to doctors.

There are existing hot debrief tools; for example, STOP 5 and Take STOCK; however, creating a specific tool with QI methods, tailored to the specific ED context, is likely to produce higher levels of multi-disciplinary team engagement and result in distributed roles and responsibilities. Change is accepted when people are involved in the decisions that affect them and when they have the opportunity to influence that change. This approach is more likely to be achieved through distributed leadership rather than from more traditional top-down hierarchical leadership approaches.

To the best of the authors’ knowledge, this study is the first of its kind to integrate Royal College Quality Improvement requirements with a collaborative and distributed medical leadership approach, to steer a change project in the implementation of a hot debrief in the ED. EDs need to create a continuous quality improvement culture to support this integration of leadership and QI methods combined, to drive and sustain successful change in distributed leadership to support the implementation of clinical protocols across the multi-disciplinary team in the ED.

The paper discusses how a decision analytic framework has been used by an English health authority in relation to the commissioning of ambulance cardiac services. Strategies for the management by ambulance personnel of victims of cardiac arrest and persons with acute chest pain of cardiac origin were modelled in a decision‐event tree, and a bibliographic database established. The international research literature prior to 1997 was searched in order to derive probability values for the tree. However, after checking whether the sub‐groupings of results in the papers were in accordance with the variables in the tree, the number of useful papers on acute chest pain was found to be only two. In the almost complete absence of information ‐ even from small observational studies ‐ on the management of the great majority of patients with cardiac symptoms transported by ambulance, the local ambulance service and the main providers of hospital services in the district are now collaborating in field studies of cardiac care in order to improve the inputs into the model.

The purpose of this paper is to investigate the impact of health-care quality of emergency medical services on brand equity of cardiac institutes by using industry-specific measure, 5Qs model of health-care service quality (HCSQ).

Survey method technique has been used to collect data from the patients availing emergency medical services from 12 cardiac institutes. Effective responses have been received from 393 patients from four localities. Systematic sampling technique has been used to collect data from the respondents. Partial least square structural equation modeling using smartPLS 2.0 has been used to analyze the results.

Findings of the study reveal that HCSQ has weak relationship with hospital brand loyalty but strong relationship with brand image and brand awareness. Furthermore, brand awareness and brand image have strong relationship with brand loyalty. Furthermore, brand image and brand loyalty have strong relationship with overall hospital brand equity but found nonsignificant relationship of brad awareness with overall hospital brand equity.

The principal contribution of the paper is to provide the insight on the impact of emergency HCSQ on brand equity of the private cardiac hospitals. Second, this study is first in branding literature that has used industry-specific scale 5Qs model to measure the service quality of emergency medical care and its impact on private sector cardiac hospital’s brand equity. Previously researchers used generic scales that were insufficient to measure the service quality of specialized industries (Babakus and Mangold, 1992; Carman, 1990; Caro and Garcia, 2007).

An “event” tree technique was used alongside conventional methods for structuring and reporting an audit of ambulance services in Lancashire, UK, for patients with suspected acute myocardial infarction (AMI) and cases of cardiac arrest. The audit covered 4,100 patients attended by ambulance crews. Cross tabulations showed that audit targets were not achieved for recording heart rhythms in non‐arrest cases, administering aspirin and intravenous cannulation. The event tree, linked electronically with the audit database, demonstrated explicitly that only one‐third of non‐arrest patients received all three procedures. With cardiac arrests, the event tree showed that survival rates to hospital were similar for patients in ventricular fibrillation who were defibrillated regardless of whether or not they received anti‐arrhythmic drugs. Interpretation of their performance levels is facilitated by the event‐tree technique that allows relationships between clinical procedures and outcomes of ambulance journeys to be displayed.

The Department of Health and the Cabinet Office's Regulatory Impact Unit want to eliminate unnecessary bureaucratic burdens on front‐line NHS staff. They asked the National Patient Safety Agency (NPSA) to look at the pattern of telephone numbers used by NHS acute trusts to summon the emergency teams that deal with cardiac arrests and the feasibility of introducing one telephone number for cardiac arrests across all hospitals. Greater staff mobility, the increased use of agency and locum staff due to mergers and an increase in the number of trusts using more than one telephone number to summon hospital crash teams mean heightened risk of confusion and possible delays in treatment for patients. A survey of NHS acute trusts found that at least 27 different crash call numbers were in use in NHS hospitals. The number 2222 was the most frequently used crash call number. The NPSA recommended in a Patient Safety Alert issued in February 2004 that all NHS organisations providing acute services in England and Wales should plan to use this as their standard crash call number.

The paper aims to study the relationship between hospital quality and hospital profits for a sample of 88 Alabama hospitals.

Quality is measured by three groups of procedures performed on newly admitted patients as suggested by the health quality alliance (HQA). Profit is measured for eight hospital services. Regression analyses tested the underlying relationships.

Quality of care for newly admitted cardiac and pneumonia patients are indicators of quality translatable into profits. Given a choice between the two, the pneumonia procedures were more effective in predicting profits.

As one of the early extensions of the HQA methodology, this paper does demonstrate linkages between quality and profits. Total number of employees was not significant, but governmental versus non‐governmental hospital analyses provide promise for future research.

The purpose of this paper is to explore the issues around the considerable increase in emergency calls experienced by a large county ambulance trust and implications for the implementation of government policy in relation to the English National Health Service Ambulance Service.

The paper involves a literature review and the analysis of the ambulance service data based on emergency call outs, and discussions with senior ambulance and health authority personnel.

Increased calls were mainly explained by a large increase in cancellations, especially after the vehicle had arrived at the scene. The term “cancellation” is potentially misleading and may carry connotations of wasted resources. There was little evidence of inappropriate calls and no single cause of cancellations or any simple solution. Instead, a wide range of actions were included, many of which seem potentially worthwhile. However, the way the data are presented disguises their diversity and potential value. This reflects the tension between policy and practice, and organisational culture and performance measurement regime.

This is a single case study and is limited by the parameters of the data base gathered by the ambulance service as part of their normal operational procedures.

This paper gives support to the enhanced role of the ambulance paramedic and the need to recognise this changing role through a more appropriate approach to performance measurement. The present emphasis on response times and transportations to hospital may result in undervaluing activities at the scene.

The paper identifies a key area where research into policy and governance issues has been limited and presents recommendations for future analysis.