Title: Evaluation of Patients with hypoxemia that resulted in the activation
Bill Kinnard, J. Barton, A. Kreeger, E. Teed, M. Maxwell

Background:
Our Medical Emergency Team collected data on patients physiological reasons for MET activation. Top three conditions were Hypoxemia, Altered Mental Status and Hypotension. Hypothesis was hypoxemia due to increased use of hydromorphone and promethazine in the post operative patient like our sister hospital.

Purpose/Objective
Evaluation of Patients with hypoxemia that resulted in the activation of the MET in a 174 bed community hospital.

Methods
Performed retrospective chart review on all patients who had a MET call due to hypoxemia

Results
Only one patient requiring a MET call for hypoxemia was a post operative patient. Overuse of opiates in the post operative patient was NOT seen as the number one reason for the MET calls. Fluid overload was the number one reason in almost one quarter of our patients. We also discovered that almost half of the hypoxemia MET calls occurred within twelve hours of admission, Forty one percent occurred on a non monitored care floor. Fifty two percent of those patients rescued were transferred to a higher level of care.

Conclusion
All patients being admitted to Medical Surgical would have their vital signs recorded every four hours for a minimum of twenty four hours post admission. We will review the admission criteria for both Telemetry and Medical Surgical to see if any of these MET call patients should have been placed in a higher level of care upon admission.
[top]

2. Branding a Medical Emergency Team Promotes Spread at an Acade
Eric Bakow
Email: ebakow@wpahs.org

Background: Allegheny General Hospital (AGH) is an 82 bed tertiary care teaching hospital. We recognized that clinical staff and employees routinely receive education about new programs. We wanted to ensure that the MET education stood out.

Purpose/Objective: We sought to facilitate education and successfully implement a MET in a complex clinical environment by using a marketing technique (branding) to launch this new clinical program. Our goal was to implement the MET for the whole hospital on Day 1.

Methods: Ownership of all design decisions including call criteria, process flow and education was conferred to a multidisciplinary team. Special attention was given to choosing the name “MET” and the logo choice. The selected logo was used on agendas, educational flyers, posters, table tents, laminated pocket cards and tee shirts. Traditional education processes were employed.

Results: The MET started on March 20, 2006. In the first 6 weeks of activity there have been 46 MET calls on 13 units (avg. 1.1 MET/day). Ancillary units’ including Physical Therapy, Interventional Radiology and the GI Lab have also called METS.

Conclusions: The branding of the MET promoted spread and understanding of core issues such as call criteria and process flow.
[top]

4. Sentara Health Care Medical Response Team Success
William Brock, S. Darwin, T. Liske
Email: wabrock@sentara.com

I. Background
Early intervention has shown to decrease mortality and morbidity. Rapid Response Teams have been developed to assist with these early interventions.

II. Purpose/Objective
Medical Response Teams (MRT) were implemented in each of the six Sentara Hospital to decrease the number of codes outside the ICU and to identify key triggers and interventions.

III. Methods
The MRT responder documents why the call was initiated, interventions employed, and outcome or disposition of the patient after the call, on a standardized data collection form. This data is analyzed and distributed on a monthly basis.
Run charts are generated displaying the number of MRT runs and the number of codes outside the ICU for each facility.

IV. Results
MRT has responded to 673 calls in seven months. Change in respiratory status has been the most frequent criteria for call. Patients were able to remain in their current unit 45% of the time. The number of actual codes outside the ICU has decreased by 6.3% from 2004 to 2005 and the MRT responders’ perceive their interventions as preventing codes in 63% of the runs.

V. Conclusions
MRT positively impacts patient outcomes at our facilities. Continued data analysis is needed to identify areas of success and opportunities for improvement. Data drives improvement.
[top]

5. Antecedents to Arrest in Hospitalized Pediatric Patients
Jeffrey Bruckel
Email: JBruckel@unch.unc.edu

Background:
Cardiac arrest events are rare in hospitalized pediatric patients but are associated with high mortality rates. Several studies have described antecedents to cardiac arrest in adult patients but little is known regarding antecedents to arrest in hospitalized pediatric patients.

Purpose/Objective:
To evaluate antecedents to arrest in hospitalized pediatric patients.

Methods:
This was a retrospective review of all pediatric patients suffering an arrest event outside of the intensive care units over a three year period. Charts were reviewed for the presence of antecedents in the twenty-four hour period preceding the arrest event.

Results:
Twenty two patients experienced an arrest event outside of the intensive care and 73% of these patients had evidence of clinical instability documented in the medical record prior to the event. The most common antecedent was staff or family concern about patient condition.

Conclusions:
We identified a significant prevalence of documented clinical instability in pediatric patients prior to arrest. Three patients experienced an event after a family member expressed concern over their condition to a level that it was documented in the medical record. With the information obtained in this study, we have designed and implemented a pediatric rapid response team system with activation criteria that includes family concern regarding the patient’s condition.
[top]

7. Critical Rescue - Banner Thunderbird Medical Center
Judy Crook, P. Farrer,
Email: judy.crook@bannerhealth.com

I. The success of any new MET hinges on the how the program is introduced, implemented, and maintained.
II. Aggressive and creative “publicity” has helped to “hardwire” this program into our hospital’s culture.
III. Our MET was designed by an interdisciplinary group with a broad staff representation. The team quickly identified they would need a great deal of publicity within the hospital. They quickly named our team CRITICAL RESCUE and promoted it aggressively before go-live. Creative education focused on the increased patient safety and additional SUPPORT for the bedside nurse. Ongoing education of staff (existing staff, new hires, and students), periodic updates to the hospital regarding the program’s impact, and recognition of the staff initiating and responding to the CRITICAL RESCUES have been key tools in maintaining our CRITCAL RESCUE TEAM.
IV. Critical Rescue’s outcomes are similar to those reported by other programs. It is difficult to measure how well a program is “hardwired” into a culture, but one only needs to walk the halls and speak with the hospital staff to recognize they feel supported and highly value this program.
V. Any hospital trying to develop and implement a RRT/MET can benefit by utilizing ongoing, supportive, and creative communication.
Author Comments:
Our Poster is 3' x 8' and shows the concept of Critical Rescue visually. It gives an overview of the CRT process. It will have the most current data regarding the CRT usage, operational data, and outcomes data. It will be accompanied by a looping professionally produced video we put together to show our CRT responders the impact that they have on our staff and patients (also to be used for recruiting). Samples of our publicity will be displayed.
[top]

8. An Early Nursing Intervention Team: above and beyond Rapid Response Teams
Mary Lu Daly
Email: marylu.daly@viahealth.org

Modeled after Rapid Response Teams (RRTs), an Early Nursing Intervention Team (ENIT), was developed to improve patient outcomes. It is a nurse-led team comprised of the critical-care nurse and the general duty nurse. ENIT takes the RRT concept a step further by “rounding” daily on patient care units.
The purpose of ENIT is twofold: to increase nursing staff satisfaction by bringing critical-care expertise to general duty units thus supporting the general duty nurse, and to improve patient outcomes by facilitating early transfer to the intensive care unit (ICU) thereby reducing adverse events.
During ENIT rounds, patients at risk are identified prior to ENIT activation by phone call. Such nurse-to-nurse consultation, a key component of ENIT, reinforces the program and focuses earlier attention on any patient care issues.
Patient data are collected in three phases: baseline data prior to the ENIT program introduction, a transitional start-up phase, and the formal study phase, which examines outcomes related to the ENIT intervention.
Preliminary data show that over a two year period, occurrence of codes on general duty units has decreased from 49% before the ENIT intervention to 21% afterward. Feedback from all nursing staff involved in the program has been extremely positive indicating that ENIT has thus far proven highly successful.
Author Comments:
[top]

9. Rescue in Medical & Surgical Patients: Impact of Patient, Nurse & Organizational Characteristics
Michael DeVita,Happ,Hoffman,Wolf,Schmid,Yookyung
Email: devitam@upmc.edu

Medical emergency teams (MET) were developed to more rapidly respond to changes in patient condition. While effective, MET do not address events prior to the response. This study examined differences in patient, nurse, and organizational characteristic for 108 MET calls on five medical and five surgical units in a university hospital. MET calls occurred more often on the 7AM–7PM shift than the 7PM-7AM shift (p=.007) for medical (p=.036), but not surgical patients. Of the 108 events, 44% were delayed, defined as events with documented evidence that pre-established criteria for a MET call were present for > 30 minutes. More delays occurred on the 7PM-7AM shift (p=.012) for surgical (p=.036), but not medical patients. Delayed events were not related to the number of patients the nurse was assigned (p=.608). However, there was a trend for more delays when more patients were assigned (4:1=21% vs. 6:1=43%). In a logistic regression model, shift (7AM, 7PM) and patient-unit-match (medical, surgical) were significant predictors of delays. The model correctly predicted 68% of delayed events. These findings have implications for patient safety by demonstrating delays in responding to patient deterioration. Study findings indicate that a combination of patient, nurse and organizational characteristics influence timely rescue.
[top]

10. Rapid Response Teams: A rapid Success
Sharon Garretson, Mary Beth Rauzi
Email: sharon.garretson@uhhs.com

BACKGROUND:
As a reactive measure CPR is not effective in saving lives. RRT’s have been identified as both proactive and best practice, and were implemented as a patient safety measure in this small urban community hospital.

OBJECTIVES:
1. To develop and successfully implement a RRT
2. To implement strategies to promote self-sustainability
3. Illustrate a reduction in cardiac arrest, mortality and cardiac arrests outside the ICU.

METHODS:
Executive leadership support was solicited, followed by the identification of nursing and medical champions. A thoughtful, well-researched implementation plan was then developed, with education as the primary focus. Nurses and RRT responders received mandatory education appropriate to their role. The planning/implementation/education phase lasted 5 months.

Self-sustainability was achieved by encouraging staff input and sharing successes through various channels:

• RRT committee membership
• Staff meetings
• Hospital newsletters
• Documentation/audit tools
• Celebrations, etc.

RESULTS AT ONE YEAR:
89% survival to discharge,
Reduction in:
cardiac arrest outside the ICU = 73%
cardiac arrests = 48%
actual deaths = 24%
mortality = 13%

CONCLUSION:

RRT’s demonstrate an improvement in the quality and safety of patient care. Our success is attributed to the foundation laid before implementation, in particular to the extensive education of staff and the continued awareness and ensuing celebrations.
Author Comments:
Multiple graphs to support presentation are available.
[top]

11. Branding a Medical Emergency Team Promotes Spread at an Acade
Sharon Kiely MD
Email: skiely@wpahs.org

Background: Allegheny General Hospital (AGH) is an 82 bed tertiary care teaching hospital. We recognized that clinical staff and employees routinely receive education about new programs. We wanted to ensure that the MET education stood out.

Purpose/Objective: We sought to facilitate education and successfully implement a MET in a complex clinical environment by using a marketing technique (branding) to launch this new clinical program. Our goal was to implement the MET for the whole hospital on Day 1.

Methods: Ownership of all design decisions including call criteria, process flow and education was conferred to a multidisciplinary team. Special attention was given to choosing the name “MET” and the logo choice. The selected logo was used on agendas, educational flyers, posters, table tents, laminated pocket cards and tee shirts. Traditional education processes were employed.

Results: The MET started on March 20, 2006. In the first 6 weeks of activity there have been 46 MET calls on 13 units (avg. 1.1 MET/day). Ancillary units’ including Physical Therapy, Interventional Radiology and the GI Lab have also called METS.

Conclusions: The branding of the MET promoted spread and understanding of core issues such as call criteria and process flow.
[top]

12. Evaluation of Naloxone use in Medical Emergency Team Calls at
Maria Kinsella
Email: kinsellam@exempla.org

Introduction: In the second year of our team's existence, we noticed an increase in Naloxone use from 3.5% in 2003 to 14.4% in 2004.

Hypothesis: Naloxone use in MET calls at our institution correlates with the overuse of opioids in high risk patients such as the elderly or those with obstructive sleep apnea(OSA).

Methods: A retrospective chart review was conducted of all patients who received naloxone during a MET call (16 of 97) from January 2004 to January 2005. Parameters collected included time of day, peri and postoperative opioids, history of OSA, body mass index (BMI), total opiates received, and occurrence within 4 hours of a transfer.

Results: The average age was 57 years. 73% of events occurred between 7P-7A. 56% of patients received multiple opioids in the prior 12 hours. Of those, 77% received opioids within 2 hours of the event. 50% occurred within 4 hours of a transfer. 6% had an established diagnosis of OSA, 25% had a BMI greater than 30, a risk factor for OSA.

Conclusions: Our sample size was small and our review did not support our hypothesis. Overuse of opioids was seen, but not in our predicted population. The average age was less than 65 and the rate of diagnosed OSA was minimal. There was a higher incidence during the night shift when staffing levels are lower. Use of multiple opiates at frequent intervals appeared to be a contributing factor.
[top]

13. Does MET Team Maturity Affect Outcomes: A Comparison of MET Teams in a Single Healthcare System
Maria Kinsella
Email: marytarry@aol.com

Introduction: Exempla Healthcare operates 3 hospitals in the Denver area. Each hospital has a medical emergency team (MET).
Hypothesis: Outcomes from MET team calls would improve as the team matures. Outcomes measured would include number of team calls and reduction in unmonitored codes.

Methods: A review of all data from MET team calls and codes from each of three facilities was conducted. Data reviewed from MET calls included team usage, reasons for calls, shift distribution and disposition after the call. The data reviewed from codes included primary reasons for calling a code and number of codes in monitored versus unmonitored settings.

Results: The facilities have teams of varying age from 6 months to 4 years. Teams have similar data on usage based on census, shift distribution and outcomes. While two facilities have hypoxia as the primary cause, the third facility has change in blood pressure. All facilities have respiratory arrest as the primary reason for codes. The youngest team shows that almost half the patients they are called on, remain on the floor. The other two teams send the majority of patients to a higher level of care.

Conclusion: Our hypothesis that outcomes would improve with team maturity was not proven true. Each team had significant usage and a reduction in unmonitored codes. The major difference with maturity is in how the data is further used. The older teams have used MET team data to drive education efforts to prevent codes.
[top]

14. Design of a Medial Emergency Team around the rapid evaluation an
Geoffrey Lighthall
Email: geoffl@stanford.edu

Unstable patients require consideration of the uptake, delivery, and utilization of oxygen. Correct and timely identification of abnormalities in oxygen supply/ demand, intravascular volume, myocardial function, pulmonary gas exchange, and the possibility of hemorrhage--if acted upon quickly, can easily restore circulatory homeostasis. Accordingly, involvement of experienced critical care personnel and the availability of valuable diagnostic equipment and therapeutics as part of a rapid response system facilitate this process.

Features likely unique to our system are portable echocardiography, point of care blood gas, electrolyte, hemoglobin and lactate analysis, and the ability to establish continuous physiologic monitoring at the bedside (ECG, pulse ox, end tidal CO2, invasive and non-invasive blood pressures). When we have encountered delays in ICU bed availability, none have compromised the delivery of prompt and well-monitored care. Further, we rarely have to dispatch key personnel from the bedside to obtain additional equipment or supplies.

Our “mobile ICU” system has led to numerous changes in therapy and approach to individual patients. Examples are the identification of hemorrhage in two patients presumed to be septic, and echocardiographic demonstration of low to normal intravascular volumes in hypotensive patients deemed to be “fluid unresponsive” or in heart failure.
Author Comments:
I didn't end up including the structured headings in the abstract, but I think i covered all the bases.
[top]

15. Rescue Me: Effect of a Rapid Response Team on Cardiac Arrest
Alexander Martinez
Email: alexm@baptisthealth.net

Background: The median expiration rate for in hospital cardiopulmonary arrests is approximately 80%.

Purpose/Objective: Many out of hospital arrests are cardiac related resulting in VF. In contrast most in hospital arrests are preceded by clinical deterioration and result in PEA/Asystole which is associated with poor outcomes. RRT responses to this deterioration may prevent an arrest. This was the rationale utilized to justify, implement and train staff.

Methods: Conducted a non randomized study in which incidence, frequency/1000 admissions and expiration rate were recorded at South Miami Hospital over a five year period: 2001-2004 (before implementation) and 2005 (after implementation).

Results: In a retrospective audit of data prior to program implementation, the incidence of non ICU arrests was 2.04/1000 admissions (89 cases) in 2001-2004 and 1.44/1000 admissions (11 cases) in 2005 (after intervention). [29% decrease] Although not statistically significant at this time (p=0.156), a downward trend has been identified. There was no concomitant increase in unplanned ICU admissions.

Conclusions: Early intervention by RRT’s may reduce the incidence of non ICU arrests without a concomitant increase in unplanned ICU admissions. More data needs to be collected before a correlation can be established.
[top]

16. Calculating early warning scores - a classroom comparison of pen&paper and hand held computer method
David Prytherch
Email: dave.prytherch@port.ac.uk

Background
Many hospitals use systems that derive an early warning score (EWS) from vital signs (VS) measurements to assist the recognition of critical illness. These allocate points in a weighted manner based on the derangement of patient¡¦s physiology from arbitrarily agreed ¡§normal¡¨ ranges.

Purpose/Objective
Little is known about the accuracy with which EWS are calculated and charted.

Methods
The speed and accuracy of charting the weighted value attributed to each VS, and of calculating the EWS, using the traditional pen and paper method was compared with those using a specially programmed, personal digital assistant (VitalPAC„·) in a classroom study involving 21 nurses. Five different, physiological VS datasets were processed by each participant using each method.

Results
Incorrect entries/omissions occurred in 24/84 (29%) EWS computed using pen/paper and 8/84 (10%) using VitalPAC„·. Fewer incorrect clinical actions would have been initiated using VitalPAC„· (4/84, 5%) than with pen/paper (12/84, 14%). Mean times (+ SD) for completing the task of calculating and charting a set of weighted values and EWS were 67.6 + 35.3 seconds (pen/paper) and 43.0 + 23.5 seconds (VitalPAC„·).
Conclusions
Devices, such as VitalPAC„·, offer advantages in speed and accuracy of recording of EWS. This may have importance for the activation of rapid response teams.
[top]

17. Who Do We Call???.......The Rapid Response Team!
Anne Rabert
Email: asrabert@juno.com

Providing optimal patient care to all patients is a goal of every health care institution. Rapid Response Teams are one way of ensuring that patients deteriorating outside of the ICU setting receive quick assessment, interventions, and stabilization by critical care experts.

Lehigh Valley Hospital and Health Network (LVHHN), a 900 bed, tertiary health care network in Northeastern Pennsylvania, has an interdisciplinary Rapid Response Team. The goal of the Team is to reduce the instance of death or disability through early identification, assessment and stabilization of individual with deteriorating medical conditions before the condition requires resuscitation. The team has critical care expertise that provides care to a patient experiencing a rapid decline in his/her medical condition on a medical-surgical or step down unit. A multidisciplinary task force composed of senior level leadership, physicians, clinicians, researchers, and educators reviewed established RRT programs and designed one that would best serve its patient population and organizational structure. The program’s go-live date is set for February 14, 2006.

Program outcomes that are expected after the RRT implementation include increased staff satisfaction, decreased patient and hospital mortality, decreased number of cardiac arrests outside of the critical care setting, decreased need for emergent transfers into the ICUs.
Author Comments:
Since the program implementation date is 2/14/06, there are no current statistics regarding patient outcomes. The prorgam will be in existence for 4 full months at the time of the conference and the implementation strategies, team development, process refinement, lessons learned, patient outcomes, and future plans will be presented in the poster session.
[top]

18. Evaluation of Naloxone use in Medical Emergency Team Calls at
Clara Restrepo
Email: clairestrom@mho.com

Introduction: In the second year of our team's existence, we noticed an increase in Naloxone use from 3.5% in 2003 to 14.4% in 2004.

Hypothesis: Naloxone use in MET calls at our institution correlates with the overuse of opioids in high risk patients such as the elderly or those with obstructive sleep apnea(OSA).

Methods: A retrospective chart review was conducted of all patients who received naloxone during a MET call (16 of 97) from January 2004 to January 2005. Parameters collected included time of day, peri and postoperative opioids, history of OSA, body mass index (BMI), total opiates received, and occurrence within 4 hours of a transfer.

Results: The average age was 57 years. 73% of events occurred between 7P-7A. 56% of patients received multiple opioids in the prior 12 hours. Of those, 77% received opioids within 2 hours of the event. 50% occurred within 4 hours of a transfer. 6% had an established diagnosis of OSA, 25% had a BMI greater than 30, a risk factor for OSA.

Conclusions: Our sample size was small and our review did not support our hypothesis. Overuse of opioids was seen, but not in our predicted population. The average age was less than 65 and the rate of diagnosed OSA was minimal. There was a higher incidence during the night shift when staffing levels are lower. Use of multiple opiates at frequent intervals appeared to be a contributing factor.
[top]

19. Reflecting on the Development of a Regional ICU Outreach Program
Elaine Rose
Email: elaine.rose@calgaryhealthregion.ca

In 2004 an ICU Outreach Pilot Project was conducted at one of the three adult hospitals in Calgary, Alberta, Canada. This six month pilot project was fantastically successful. Then the work began to develop a business case and seek approval to implement a Regional Program that would see ICU Outreach Teams at each of the three adult hospitals in Calgary. What is done at one site cannot be dropped into place at the other two sites without some modification.
This presentation will assist you in:
a. recognizing the impact of introducing change
b. identifying the impact of cultural differences
c. identifying leadership needs
d. identifying team development and educational requirements

Stories of the successes and the challenges that occur during the stages of change can be of benefit; a means of reflection and an opportunity to grow and learn.

We will share the results of what worked, where we could have done better and what we learned, including the importance of planning, communication and data collection.

Change takes time. Our ICU Outreach Program is still in its infancy and there is much to be developed. The vision for the future is exciting.
[top]

20. Antecedents to Arrest in Hospitalized Pediatric Patients
Tina Schade Willis
Email: twillis@unch.unc.edu

Background:
Cardiac arrest events are rare in hospitalized pediatric patients but are associated with high mortality rates. Several studies have described antecedents to cardiac arrest in adult patients but little is known regarding antecedents to arrest in hospitalized pediatric patients.

Purpose/Objective:
To evaluate antecedents to arrest in hospitalized pediatric patients.

Methods:
This was a retrospective review of all pediatric patients suffering an arrest event outside of the intensive care units over a three year period. Charts were reviewed for the presence of antecedents in the twenty-four hour period preceding the arrest event.

Results:
Twenty two patients experienced an arrest event outside of the intensive care and 73% of these patients had evidence of clinical instability documented in the medical record prior to the event. The most common antecedent was staff or family concern about patient condition.

Conclusions:
We identified a significant prevalence of documented clinical instability in pediatric patients prior to arrest. Three patients experienced an event after a family member expressed concern over their condition to a level that it was documented in the medical record. With the information obtained in this study, we have designed and implemented a pediatric rapid response team system with activation criteria that includes family concern regarding the patient’s condition.
[top]

21. Calculating ealy warning scores - a classroom comparison of pen&paper and hand held computer method
Gary Smith
Email: gary.smith@porthosp.nhs.uk

Background
Many hospitals use systems that derive an early warning score (EWS) from vital signs (VS) measurements to assist the recognition of critical illness. These allocate points in a weighted manner based on the derangement of patient¡¦s physiology from arbitrarily agreed ¡§normal¡¨ ranges.

Purpose/Objective
Little is known about the accuracy with which EWS are calculated and charted.

Methods
The speed and accuracy of charting the weighted value attributed to each VS, and of calculating the EWS, using the traditional pen and paper method was compared with those using a specially programmed, personal digital assistant (VitalPAC„·) in a classroom study involving 21 nurses. Five different, physiological VS datasets were processed by each participant using each method.

Results
Incorrect entries/omissions occurred in 24/84 (29%) EWS computed using pen/paper and 8/84 (10%) using VitalPAC„·. Fewer incorrect clinical actions would have been initiated using VitalPAC„· (4/84, 5%) than with pen/paper (12/84, 14%). Mean times (+ SD) for completing the task of calculating and charting a set of weighted values and EWS were 67.6 + 35.3 seconds (pen/paper) and 43.0 + 23.5 seconds (VitalPAC„·).
Conclusions
Devices, such as VitalPAC„·, offer advantages in speed and accuracy of recording of EWS. This may have importance for the activation of rapid response teams.
Author Comments:
VitalPAC should be followed by the trademark symbol TIM in a circle.
[top]

22. Development of a Nurse Practitioner Led Rapid Response Team
Mechelle Williams
Email: mewilliams@tmh.tmc.edu

Background: Our 900+ bed medical center hospital had a growing Nurse Practitioner Program in which nurse practitioners (NP) were hired for 24/7 coverage of all acute and critical care units in the hospital. This program presented the institution a unique opportunity to develop a Rapid Response Team (RRT) with NPs.

Methods: The institution formed a RRT and named it CERT – Clinical Emergency Response Team. The team consisted of 1 NP and 1 respiratory therapist (RT) with 24/7 accountability. The Pilot started with coverage for 4 units. The education on pilot units included goal of CERT coverage, triggers for a CERT call, how to initiate a CERT call, and SBAR (Situation, Background, Assessment, Recommendations) tool of communication.

Results: 30 day Pilot period had a total of 17 CERT calls: 7 patients required transfer to an ICU for higher level of care, 1 patient was found pulseless and expired, but 9 patients were able to be treated, stabilized and remain on the floor. Average response time was 6 minutes and average length of patient visit was 37 minutes.

Conclusions: The hospital based NP is well suited as a rapid response team member.
[top]

23. Condition O: A Rapid Response Team for an Obstetrical Crisis
Marie R. Baldisseri and Karen Stein

Background:
Although most obstetrical patients are considered ‘low risk’, they may develop sudden life-threatening conditions. Our retrospective review of obstetrical patients with poor outcomes revealed that these patients often demonstrated early signs of deterioration which were not recognized.

Purpose/Objective:
By establishing clinical criteria that predict impending deterioration of the obstetrical patient, life-threatening situations can be prevented or mitigated with rapid response by a critical core of healthcare providers at the bedside.

Methods:
A multidisciplinary task force defined the clinical criteria of an obstetrical crisis and determined appropriate team members and roles of the Condition O rapid response team. Notification and education of the staff and hospital personnel was completed over several months.

Results:
From September through December 2005, 6 Condition O’s were called. During this time, reeducation and reinforcement of the criteria for calling a Condition O was performed. There was a significant increase in the number of Condition O’s with a total of 27 from January to April 2006. Most calls were for decelerating fetal heart tones, prolapsed umbilical cord, and severe shoulder dystocia.

Conclusions:
Early detection of obstetrical patients with impending deterioration using well-defined clinical criteria resulted in prompt response and treatment and improved clinical outcomes.
[top]

24. A 5 year audit of MET at a metropolitan teaching hospital.
Michael Buist, Susan Van Dyke, Ellie Abaloz, Kate Shepherd.

From: The Intensive Care Unit (ICU), Dandenong Hospital, Southernhealth, Melbourne Australia.

Introduction: Despite recent controversy over the efficacy of MET’s our hospital finds this system of management an effective way of treating acutely ill and unstable patients in the general ward environment. Furthermore the MET audit system provides a feedback mechanism to both ICU and general ward clinical staff. We report here our last 5 years experience and outcomes.

Methods: Our MET has been previously described (1). Audit data is collected on a 2 sided A4 paper record during each MET call. Each week this data is entered into the ICU audit software package. This information is presented each week at the ICU audit and issues discussed with relevant ward staff. Patient hospital outcomes are downloaded of the patient administration system.

Results: There was a total of 1627 calls (27 calls per month in a 300 bed hospital) of which 231 were for cardiac arrests. Of these only 119 were true cardiac arrests. Oxygen desaturation, hypotension to < 90mmHg, loss of consciousness and “worried” were the most common call triggers. The MET event outcome was ward management and or resolution in 63% of calls and only 1.6% in death. The MET hospital outcome was death in 27% of calls.

Conclusion: Despite the low MET call death rate a significant number of these patients did not survive to hospital discharge. The audit system is a useful tool for MET data collection and management.
[top]