Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2025
Summary
The Sunshine Coast Hospital and Health Service Acute Resuscitation Planning (ARP) Scorecard was developed to detail the prevalence of ARPs in the inpatient setting.
Implementation sites: Sunshine Coast Hospital and Health Service
Project dates: January 2024 - February 2025
Partnerships: N/A
This project was presented as a Poster at CEQ Showcase 2025 (PDF 473KB).
Aim
The Acute Resuscitation Scorecard aims to identify clinical areas where there are opportunities to better engage patients in decisions about their future care, and drive improvements in the number of patients with an ARP in place.
Outcomes
- Reduction in the unexpected death rate (where no ARP was in place at time of death) following Medical Emergency Team (MET)/Code Blue calls from 2023 to 2025 o 2023 = 0.18/1000 admissions o 2024 = 0.11/1000 admissions o 2025(YTD) = 0.06/1000 admissions
- Increase in the number of people with an ARP in place at the time of a Medical Emergency Team (MET)/Code Blue call
- 2023 = 46.6%
- 2024 = 48.6.2%
- 2025(YTD) = 51.6%
- Improvements in ARP rates for older patients admitted to hospital against targets. Age group - February 2024 - February 2025 - Target >90 years 80% 82% 85% >85 years 72% 75% 70% >75 years 57% 63% 60% >65 years 50% 56% 50%
Background
An ARP is an important medical order that informs urgent care to be provided in the event of a sudden deterioration in a patient’s condition. The document guides clinicians’ conversations about providing CPR, ceilings of medical interventions, advance care planning, people to involve in health care decisions, and preferences for escalation of care with patients at risk of deterioration.
A previous retrospective chart audit of patients who had suffered an in-hospital cardiac arrest, and those requiring attendance by the Medical Emergency Team (MET) completed in January 2024 revealed that ARP prevalence within SCHHS inpatient facilities was low. Opportunities to improve shared decision-making with patients and their families were identified.
Methods
The development of the ARP Scorecard was undertaken under the auspices of the Recognising and Responding to Acute Deterioration (RRAD) Standard 8 Committee, in consultation with the Comprehensive Care Standard 5 Committee. The committee members provided advice about the data parameters and the associated activities that would be required to support the initiative.
This ARP Dashboard project was undertaken using the Lean Six Sigma Project Management Principles: Define: Findings from the Cardiac Arrest audit completed January 2024 and MET outcomes data provided evidence about the extent of the problem and allowed us to develop a problem statement: “At Sunshine Coast Hospital and Health Service, patients may not have an ARP in place which could lead to care being provided that does not align with patients’ wishes, priorities and preferences, and that may be non-beneficial”.
Measure: A minimum data set of demographic and clinical information was compiled and included the name of the SCHHS hospital facility, episode number, medical record number, admitting and discharge unit, patient age, admission and discharge time, date of death (if applicable) and the date of the ARP (if applicable). Data were sorted into age groups: >65 years, >75 years, >85 years and >90 years. The Patient Safety and Quality Data Analyst built a dashboard, and this was published after thorough testing. The scorecard can be sorted by facility, Directorate, admitting and discharge team and ward.
Analyse: Data are now presented monthly at Directorate Safe Care Committees, and quarterly at RRAD and Comprehensive Care Committees.
Improve: To support the dashboard, an ARP Procedure was published that included potential triggers for commencing discussions about resuscitation planning. Staff roles in resuscitation planning were described for not only medical, but also nursing and allied health staff, from reviewing a current ARP to ensure it was in date, to commencing goals of care discussions provided they felt confident and skilled to do so.
An education package that described the importance of discussions about resuscitation, staff roles and importance of working to full scope of practice, and promoting quality end of life care was also developed.
Outcomes of the initiative include:
- reduction in unexpected deaths from Medical Emergency Team calls
- improvements in ARP rates
- identifying teams and facilities where communication with patients could be improved and responding with targeted education and advising senior clinicians and Safety Improvement Support Officers (SISOs)
- increased awareness of the importance of conversations for patients at risk of deterioration
- empowering staff to work to full scope of practice. Control: Ongoing monitoring of ARP data is undertaken by SISOs, who present the data at monthly Directorate Safe Care Committees, and by the End of Life Care Standard Lead quarterly at RRAD and Comprehensive Care Committees.
Discussion
Initial data from the Cardiac Arrest Audit (January 2024) helped support early identification of the extent of the problem, being low ARP rates. Crucial to the development of the ARP Scorecard was the early engagement of senior clinicians via the membership of the RRAD and Comprehensive Care Committees and associated Executive Sponsors. This required us to develop a shared understanding of the breadth and extent of the problem, the advantages and limitations of the data, and how the data would be used.
Taking time to work through issues such as ward or service inclusion and exclusion criteria (e.g. outpatients vs admitted patients, adults vs paediatrics), and how data would be presented within a no-blame culture was more important than rushing to a publication deadline. Considering the Scorecard as part of a broader piece of improvement work that also included developing a procedure ensured there were processes in place for reporting, and implementing quality improvement activities. Automating data collection from existing ieMR data reduced the data collection burden on individual staff moving forward.
Having a core group of staff driving the project with the guidance of HHS-wide committees and support of an Executive Sponsor helped to ensure the success of the project. This project has now been embedded in business-as-usual processes. The ARP Scorecard could be implemented in any other HHS using eARPs as part of ieMR.
References
Basubrin, O. (2024). Assessing Medical Students' Understanding of Do-Not-Resuscitate (DNR) Orders. Cureus, 16(9), e69132. doi:10.7759/cureus.69132
Pearse, W., Oprescu, F., Endacott, J., Goodman, S., Hyde, M., & O’Neill, M. (2019). Advance care planning in the context of clinical deterioration: a systematic review of the literature. Palliative Care: Research and Treatment, 12, 1178224218823509. doi:10.1177/1178224218823509
Tirkkonen, J., Setala, P., & Hoppu, S. (2017). Characteristics and outcome of rapid response team patients >/=75 years old: a prospective observational cohort study. Scand J Trauma Resusc Emerg Med, 25(1), 77. doi:10.1186/s13049-017-0423-8
Key contact
Dr Wendy Kinton
End of Life Care Program Coordinator
Sunshine Coast Hospital and Health Service