Health technology assessment of cardiopulmonary resuscitation and survey of public opinions on Do Not Attempt Resuscitation orders

Abstract

In this age of evidence based medicine and the “litigation nation” culture, “patient safety” is the ethos which underpins ethical and efficacious medical practice. Research into Patient Safety is unique. One way is that it begins with an event of iatrogenic injury or questions the utilisation of interventions with unproven efficacy. This research aims to analyse the antecedent cause of errors which result in accidents and poor patient outcomes, then evaluate methods to prevent such errors and hence improve outcomes.

This thesis was written with two main aims. My initial aim was to evaluate human error causation and prevention, with special reference to Life Support Training. This was achieved via literature review, systematic review, surveying and descriptive analysis. In response to the rich and underexploited research need highlighted, I set up a national network to devise and progress research in the field of simulation and team training.

My main aim was to meta-analyse the effectiveness and cost effectiveness of life support interventions including survival rate and long-term outcome of patients who have suffered cardiac arrest. This was achieved in a health technology assessment which included a nested survey of public opinion on the use of Life Support and Do Not Attempt Resuscitation advance directives. The findings of this HTA necessitated and informed the design of the protocol for the prospective study of long-term outcome.