What is a code sucess outcome?????????

[aussiephil]

I know this may sound like a strange question, but, I am curious following a discussion in the chat.

There seems to be 2 distinct lines here & I can see both sides. So lets debate it!

The 2 lines are:-

1. The pt is delivered to hospital with an outcome - Doesnt matter if the pt only lives a short time on a ventilator, it a sucess because the family said goodbye.

2. The pt walks from hospital & is able to contribute to society in a meaningful way after hospitalisation.

Do we like to think it is the first to pat ourselves on the back to boost our stats? Or should we take a fresh look at the benefits of allowing the families to have peace with the patient?

Looking forward to the replies

Phil

[BushyFromOz]

The problem here is people usually refusing to seperate emotions from statistics.

Number 1 is a nice to have, but you havn't really saved anything have you? end result is they are still dead

Number 2 is a definitive example, where quality of life can be quantified and a person lives to function in a relatively normal manner

[zippyRN]

ROSC / ROSR by EMS is a proxy for EMS success

ROSR and concious on arrival to the ED is a success for EMS

survival to Discharge is one measure of whole system performance, as is survival to 6months, 1, 5 ,10 years, and return to work ...

[nsmedic393]

I agree with zippy. Any ROSC is a measured ammount of success for us in ems. Not soo much for statistical purposes but to say that we did our job, did it well and achieved something that is very difficult to do. Of course that is of no consolation to the patient. The family being able to say goodby is also a small goal achieved.

Our statistics in survival rates only account for patients that live to one year after discharge and that is a true success and a measurment of how good the system on a whole is. Although if it weren't for EMS being the first link in the chain the ressuscitation rate for cardiac arrent in the home would be 0% as opposed to a whopping 3%.

[Just Plain Ruff]

The only codes that I consider success are the ones who walk out of the hospital. Those that I get to the ER witha pulse but still die are not successful codes - they are dead dead dead.

I had one lady who arrested in our ambulance, 2 shocks later , cpr and meds in the er and then flown to a cardiac center and she went home a week later. That in my book is a success.

Ventillator dependent vegetable is not a success.

[Dustdevil]

Interesting question. I am not personally convinced that the extra period of time to "say goodbye" is a positive thing. I have been in that position with loved ones in the past. Once it was a good thing. Another time it was not. And really, I'm not sure that it is really any easier to deal with the loss, given that extra little bit of time. If it helps somebody, then yes, it's a good thing. But is it worth risking lives for? I don't think so.

[bbbrammer]

I don't think of it in success or failure terms. We are on this earth with all the meds we have found, we have done as much training as possible to fix a human body that may not be fixable. I don't get elated with the 'successful' ones or depressed at the 'failures'. I just look at it as doing the best job I can with the best tools I have in my armorment, after that it is up to something or someone else to take it from there. No matter what I do on a code, if the patient wants to live then my interactions gives them a chance at that. If the patient wants to die, no matter what I do will make a difference. Is that a 'failure'? I don't think so. I did the same thing for them as I did for the one who walked out of the hospital. I did my job. It was up to the patient and/or a higher power that decided whether it was a 'success' or a 'failure'.

[ERDoc]

I think it depends on what setting you are using it for. If you mean a personal success, then it is whatever your personal beliefs define it as. If you are looking a what the literature uses to determine success, then it is whatever the study authors define their endpoint to be.

[BushyFromOz]

How can you define "success" and "save" as the same thing?

A successful resuscitation has ROSC, does not necessarily mean you have "saved" them from dying?

[Just Plain Ruff]

A ROSC is someone who had return of circulation but also may have eventually died.

A save is someone who had an arrest and survived to discharge. My opinion of a save is one who left the hospital with minimal function loss. Someone who leaves the hospital a Ventillator dependent person or someone with significant loss of function and a large decrease in Activities of daily living I don't classify as a save. Did we do them any good?