Out of hospital cardiac arrest: strategy 2021 to 2026

8. Data and Innovation

We will ensure access to timely, high quality data to facilitate open review, discussion, learning and action planning.

Aims:

1. Our use of data will help us to understand and address variation and improve outcomes after OHCA.

2. Innovative solutions are used to tackle the key challenges relating to OHCA.

To support all the ambitions of this strategy it is important that we have access to, and effectively utilise, data to understand the system of care required to preserve life and provide support for those affected by OHCA^{[58] [59]}.

Access to this information enables us to understand where inequities exist, and where improvements can be made. Ultimately, this supports our ability to direct our actions and resources in the most effective way to improve outcomes from OHCA across Scotland.

The OHCA Data Linkage Project

As part of the 2015 OHCA Strategy we established the OHCA data linkage project^[60]. This gave us an effective base upon which to begin to measure progress towards our aims. For example, we were able to show an increasing rate of bystander CPR, and identify trends in public access defibrillator deployment both of which were key components of the first strategy.

The key clinical outcome after OHCA is long term patient survival. Our data linkage reporting helped us show that across the lifetime of the strategy the number of people who survived to leave hospital after an OHCA increased from 1 in 20 to 1 in 10^[61].

Next steps in data analysis

Survival is an important measure, but cannot be considered in isolation. Preparing communities and responders to intervene appropriately in the community, returning people to their families where possible after OHCA, and supporting them through their survivorship^{[62] [63]} requires a multi-faceted approach. In this context survival is not always the most important outcome, and is certainly underpinned by a range of crucially important process measures over which we have more direct influence.

We will continue to identify key metrics in the augmented chain of survival and find ways to measure what is important to delivering our aims.

By taking this approach our data linkage work has already enabled vital insights about where we should focus our attention as we move forward with this refreshed strategy. We now have the opportunity to develop this further by modelling changes to the chain of survival in Scotland to see where improvement will have the most impact.

We will work collaboratively with the Scottish Cardiac Audit to link SAS data about OHCA with detailed data held about cardiac care, to understand the cardiology care that people who experience an out of hospital cardiac arrest receive and how this impacts on their outcomes.

Similarly we wish to work with Intensive Care colleagues to take advantage of the high quality audit information stored in Scotland's unique healthcare databases to facilitate innovation and excellence in care across Scotland's ICUs that will promote best practice.

Analysis of Scottish OHCA outcomes has shown that people living in more deprived areas remain more likely to experience an OHCA and that people from deprived areas are still less likely to survive following OHCA. Deprivation also has a significant effect on the likelihood of receiving bystander CPR^[64].

A weight of international literature also makes us aware that the intersection between OHCA and gender, ethnicity, mental illness, and other comorbidities creates particular challenges for successful prevention and resuscitation. We will endeavour to combine OHCA data with insight from other sources in order to develop more effective systems of care.

Scotland's communities are characterised by variation, including geography, deprivation and age demographic. Often these characteristics will have an impact on OHCA outcomes, some of which are better understood than others, and can point us towards bespoke local considerations to be addressed in terms of the application of the key links in the chain of survival.

In addition where communities are more similarly configured but outcomes vary, this raises the potential for learning between systems in an attempt to improve outcomes. The key is intelligent use of data to understand variation and the factors that underlie this variation.

Our analysis of the whole patient journey after OHCA has also illuminated the crucial importance of respect for the wishes of individuals in respect to end of life care^[65].

It reinforces the importance of enabling meaningful conversations between people, their families and those who support their care and wellbeing, about what they would wish to happen if they become unwell and face the scenario where resuscitative interventions may be applied.

Not only are these conversations to be encouraged but their output needs to be captured, and crucially to be available to emergency services in the minutes between a 999 call being received and a resuscitation commenced. This would help families cope with bereavement knowing that the wishes of their loved one were respected, help guide the efforts of clinicians, and most importantly seek to preserve dignity in death. We wish to explore innovative digital and communications solutions to the challenges this entails.

Technological innovation

Finally, addressing OHCA lends itself to the application of established and emerging technologies. These include using video for real time support, effective audit of care delivery, technology to support recognition of OHCA including application of Artificial Intelligence, and the use of geospatial technology to enable resource location and utilisation (for example locating PADs or community responder resources).

It is our intention to work closely and collaborate widely with industry, clinical and academic partners in order to make the augmented Chain of Survival in Scotland an international example of best practice with regards to its use of technological innovation.

Actions:

1. We will develop a monitoring and evaluation framework for this strategy which will be focussed on key process measures of care for patients after OHCA.

2. We will link data about OHCA with data about gender, ethnicity, mental illness, and other comorbidities to identify and address unwarranted variation.

3. We will harness the potential of data held in Scotland's national ICU audit and cardiac audit through linkage with the Scottish Ambulance Service data.

4. We will develop a plan to use innovative digital technologies to interact with the public and facilitate bystander action in response to OHCA.

5. We will facilitate collaboration between strategy delivery and academic partners to answer key questions about OHCA.

6. We will work with colleagues in primary care to implement solutions to the challenges of timely communication of anticipatory care plans and decision support for front line ambulance service crews in dealing with complex end of life care decisions.