The NCAA Annual Meeting is a fantastic opportunity for all NCAA participants to come together in a supportive and collaborative environment, so they can:
- network with other NCAA participants;
- share best practice with each other;
- seek answers to their data collection, validation and analysis queries;
- learn about the latest developments in NCAA; and
- discuss issues with the NCAA Team.
Summary of the Eighth NCAA Annual Meeting #NCAAAM18
15 November 2018
For the Eighth NCAA Annual Meeting we went back to where it all began, the Wellcome Collection, the venue of our first Annual Meeting back in 2011. However, this day was all about looking forward rather than backward. The event was opened by Jerry Nolan (Chair of the NCAA Steering Committee) who welcomed around 130 delegates; Resuscitation Officers, Consultants and Clinical Audit staff, from across the UK. Building on last year’s trial run with polling platform Sli.do, delegates were encouraged to keep their phones handy and submit questions and suggestions in real-time.
Session: National clinical audits of cardiac arrest
NCAA Programme Coordinator, Sarah Furnell, delivered her first NCAA Update, introducing the new NCAA team and giving a brief recap of the activities of the past year. Prof Gavin Perkins of Warwick University provided a counterpoint with an update on the Out of Hospital Cardiac Outcomes (OHCAO) Group. He just had enough time to answer some questions from the audience before rushing away to another meeting across the country.
Jas Soar took the audience on a whirlwind tour through the latest NCAA Key Statistics for 2017-18. The rate of arrest per 1000 hospital admissions continues to decrease over time, while outcomes continue to improve. NCAA’s long-term aim has always been to be so effective as to become obsolete. It will be a while before we do ourselves out of job, but the implications for patient care are encouraging.
After a positive reception at last year’s event, Peter-Marc Fortune delivered a dedicated paediatric session, looking at Key Statistics for 2013-18.
Both reports are now available online.
Session: NCAA hospital case studies
One of the most anticipated experiences of any NCAA Annual Meeting is the opportunity to hear how other hospitals are using their data to drive quality improvement. This year’s speakers didn’t disappoint.
Kim Watts from Chelsea and Westminster Hospitals Trust spoke about the work she undertook for her MSc project. Using NCAA data to identify a cohort of cardiac arrest patients across the Trust, she then compared NEWS trajectory and vital signs in the 24 hours prior to arrest. Her findings have influenced training guidelines at her Trust.
Through their comparative NCAA report, Luton and Dunstable noticed their arrest rate was higher than many other participating hospitals. They started investigating the root causes of cardiac arrest at their site and putting targeted measures in place to reduce incidence and improve early decision making. As a result, the arrest rate dropped and survival to hospital discharge improved. Sara Morrison, Lead Resuscitation Officer at Luton and Dunstable University Hospital, proved an engaging spokesperson for the use of NCAA data locally.
Finally, we heard from Lisa Ward and Claire Stocks of County Durham and Darlington NHS Foundation Trust, who detailed their hospitals’ holistic approach to improving care and outcomes. Over a six-year period the newly titled Cardiac Arrest Prevention Team at CDDFT undertook an ambitious project to review, improve and ensure the relevance their service to both patients and staff. The project compromised five work-streams. 1. Data Collection and Quality, including signing up to NCAA. 2. In-depth case review. 3. Identification of ‘hot spots’ are delivering targeted improvements such as extra training. 4. Implementing, an electronic observation system combined with a bespoke escalation pathway. 5 Developing and implementing an ‘Acute Intervention Team’. Over the course of this period, the incidence of cardiac arrest has reduced 46%.
Session: NCAA public reporting
During the networking lunch delegates had the opportunity to visit information stands, including the NCAA Helpdesk, Digital Helpdesk and medical equipment supplier; Cardiac Services. Jerry Nolan kicked off the post-lunch session with an update on the road to public reporting. He was followed by Professor David Harrison, Head Statistician at ICNARC who spoke on how NCAA is “ensuring fair comparisons”. The first section of his talk detailed the recent recalibration of the risk model. As outcomes steadily improve across the audit, it is important to reset the benchmark. In the second section, Prof Harrison presented the results of investigations into the influence of co-morbidities on outcomes. Two years of NCAA data was linked with Hospital Episode Statistics (HES) data to identify co-morbidities in the cohort. In one of the great surprises of the day, while some comorbidities were shown to have an important association with ROSC > 20 minutes and/or hospital survival, when used in the risk model, these data had very little impact on the overall accuracy of risk-adjusted comparisons between hospitals. The conclusion was that while we should move towards collecting some comorbidity data, this should not hold up a move toward public reporting for NCAA. This session provided some of the liveliest debate of the day, with most delegates agreeing that the move toward public reporting should go ahead and will ultimately strengthen NCAA’s position.
Session: NCAA and research
Senior ICNARC Researcher, Dr Doug Gould gave us an overview of ongoing research with NCAA, including updates on the “ReSPECT evaluation study” and “Effect of hospital resuscitation service provision on survival from IHCA”.
Dr Matt Thomas, Consultant Intensivist at Southmead Hospital, spoke about the dearth of information surrounding cardiac arrest in the ICU. Very little research has been done in this area worldwide and it is ripe for exploration. The largest case-series looking at arrest in ICU took place in Finland from 2003-2013 and delegates were event treated to a quick Finnish lesson. In conjunction with ICNARC, Dr Thomas is planning a prospective study to help see past the “event horizon” of cardiac arrest in the ICU.
Lastly, Jerry Nolan helped put this work into context, guiding us through the wider research landscape and how NCAA can and does contribute.
Session: The Future of NCAA
After a well-deserved tea break, the floor was open to the delegates, using both Sli.do and old-fashioned hand-raising to gather opinions and ideas around two key topics. Sarah Furnell lead the workshop on improving current hospital reports and guidance. While Jane Carnall (Resuscitation Officer representative of the NCAA Steering Group) quizzed the audience on the how to grow and optimise communication strategies between NCAA and its participants, and between the participants themselves. In a poll on the potential use of social media, closed forums such as Facebook groups were more popular than open forums such as Twitter. The NCAA team are still sifting through some of the Sli.do suggestions and buzzing with ideas.
This year’s prize winners for exceptional participation, selected by the NCAA team at ICNARC, were announced and presented by Sarah Furnell (NCAA Programme Coordinator) and Tyrone Samuels (NCAA Data Coordinator). And the winners were (drum roll) …
Most Efficient Data Validation
- Broomfield Hospital – Prize was collected by Nicola Boutilier (pictured above)
- South Tyneside Hospital
Most Improved Data Validation
- Queen’s Hospital, Burton
- Royal Albert Edward Infirmary
Unfortunately, the representatives from Queen’s Hospital, Burton had to rush to get their train, but a box of chocolates and certificate are wending their way in the post.
Most Improved Data Quality
This was a special prize for individuals who went above and beyond in 2018 to ensure the quality of their historical data.
- James Fenwick (pictured) from Basildon University Hospital and Essex Cardiothoracic Centre
- Steve Root from Northwick Park Hospital
Unfortunately, Steve did not attend, but the prize was collected on his behalf by a colleague. We trust that she’s delivered his chocolate to him!
Finally, Sue Hampshire, Acting CEO of Resuscitation Council UK, closed the meeting with thanking participants and organisers for an informative and thought-provoking day.
We’d like to echo her comments and say a massive thank you to all our delegates, speakers, chairs, exhibitors and ICNARC helpers for making this a great day. Next year NCAA celebrates the 10th anniversary of its first patient in, we hope you’ll join us for this special milestone.
The NCAA Team