Several critical paradigms lie at the heart of the ART program. The ART Matrix represents a strategy to categorize etiology for each at-risk patient. This facilitates a systematic approach to reducing preventable deaths within each category by targeting prevention as well as effective resuscitation. The Matrix also allows for consolidation of multiple hospital-based patient safety initiatives: sepsis, perioperative respiratory depression and sleep apnea, occult hemorrhage, dysrhythmias, deep venous thrombosis/pulmonary embolus detection and treatment, respiratory distress, neurological emergencies, and general critical care. This integration is crucial for effective hospital leadership, outcomes tracking, and training efficiency. The Matrix is based on the ART Integrated Model of Physiology, which identifies three physiological processes – oxygenation, ventilation  perfusion– that define the optimal approach to clinical practice, CQI data collection, technology, and training. Early detection of deterioration is critical for arrest prevention \cite{Nolan_2010}. Most approaches involve a critical tradeoff between sensitivity and specificity, with a measurable incidence of over- or under-utilization of rapid response team resources, limiting overall effectiveness. The ART model employs a stepwise approach to early detection that maximizes both sensitivity and specificity and integrates clinical data, technology, and hospital processes. Each Matrix category is associated with specific static and dynamic risk factors, which in turn suggest particular strategies for vital sign assessment and sensors/technology. Concerning patterns suggesting deterioration trigger a targeted diagnostic and therapeutic approach to both improve specificity and potentially reverse deterioration.
The integrative nature of the ART program is a key component to its effectiveness. In addition to integrating clinical practice, science, technology, CQI, and training, ART also brings together multiple hospital initiatives as discussed above. This allows leadership integration and enhances efficiency. Finally, ART training opportunities provide a conduit to address institutional resuscitation and patient safety needs via regular access to all clinical providers.
The ART program has been successfully implemented at the UCSD as well as the VA Medical Center in San Diego. As a direct result of ART program implementation, arrest incidence has been reduced to 50 percent of baseline values and survival following arrest has doubled and tripled.

Leadership Plan

Practice Plan

Technology Plan

Suggested practices and technologies are limited to those proven to show benefit or are the only known technologies with a particular capability. As other options may exist, please send information on any additional technologies, along with appropriate evidence, to info@patientsafetymovement.org.

Metrics

Topic

Arrest Related Death

Arrest Related Death (ARD) is defined as patients not surviving to hospital discharge who receive resuscitative efforts (either CPR or defibrillation).  

Outcome Measure Formula

Numerator: Total number of Arrest Related Deaths
Denominator: Total number of admissions
Rate is typically displayed as ARDs/admissions *1000

Metric Recommendations

Direct Impact: Any patient receiving resuscitative efforts
Lives Spared Harm: