Article Text

M7 Leading for improvement – an essential ingredient in quality patient care: A Respiratory experience
  1. S Kumar,
  2. M Gittus,
  3. A Cracknell,
  4. SDW Miller
  1. Leeds Teaching Hospitals NHS Trust, Leeds, UK


Background and objectives Many respiratory patients have deranged physiology and can deteriorate rapidly during acute episodes. Consequently, early decision-making is vital to improve outcomes and to ensure patient’s wishes are respected.

We aim to improve the care of inpatients who acutely deteriorate through clinical leadership, as part of a quality improvement (QI) collaboration, by improving early decision-making and clinical response.

As a pilot project we retrospectively (January 2012–September 2014) analysed all 2222 calls from three respiratory wards (84 beds). Fewer events occurred at the weekend (9.4% per day) compared to weekdays (16.2% per day). More events occurred between0900–1700 (41.1%) compared to out of hours (58.9%). Decision-making was found to be poor with 12.2% patients having cardiopulmonary resuscitation (CPR) decisions in place.

Methods Following initial data analysis, one ward participated in a QI project to identify areas for improvement and target these through small tests of change. The interventions implemented by the ward team included a staff survey, “deteriorating patient stamp”, post-2222 call debriefing and “safety huddles”. The effectiveness of these interventions was measured through analysis of on-going arrest calls and documentation of decision-making in case-notes.

Results Reduction in number of 2222 calls on pilot ward between pre-intervention and post-intervention time periods (mean 1.44 vs. 0.56) as shown in Figure 1.

Abstract M7 Figure 1

Total number of 2222 calls on pilot ward. Interventions indicated by lettering (A): Staff survey, (B): Introduction of “deteriorating patient stamp”, (C): Debriefing following any arrests, (D): Introduction of “Safety huddle”. Mean of pre-intervention and intervention data, 1.44 and 0.56 respectively

Total 2222 calls per bed reduced for the pilot ward (63.6% reduction) compared to non-pilot wards (9.68% increase) during the pre and post-intervention phases. Similar results were shown for cardiac arrests alone (62.5% reduction compared to 26.7% increase). Decision-making was improved through the intervention phase with 75% of inpatients having DNACPR decisions and 46% escalation plans documented. Safety huddles helped improve ward culture and spread lessons learnt from debriefing of the last 3 events.

Conclusion Early results show there has been a reduction in total 2222 calls in the pilot ward compared to the other wards. We believe this is through improved decision making and empowering frontline staff. This could be scaled-up in other wards to have greater impact on patient care.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.