Kyle Brooks on Impact of night time clinical lead role on RRT epidemiology. Recorded at the ANZICS S&Q 2014: Rapid Response Teams.

1. Impact of the night time Clinical Lead role on MET
patient epidemiology
Kyle Brooks
Senior Registrar – Intensive Care

2. To determine the impact of the clinical lead role on MET patient epidemiology
Number of MET Calls
Hospital length of stay for MET call Patients
Mortality for MET Call patients
.
Study Objectives

3. Study Design
Retrospective observational study
Comparing 12 months pre and post
Introduction of the clinical lead role

4. Who is the Clinical
Lead?

5. • Nursing staff issue clinical task requests from ward computers
• Every member of the Night Team carries a mobile device to track
their allocated tasks
• All members of the team can see all the work
• The Clinical Lead has the ability to re-allocate work according to
demand
Electronic Task Management System

6. •Monitors workload & response times
•Redistributes work between Drs
•Optimizes workflow across the team
Clinical Lead
HMOA HMOB HMOC HMOD HMOE Gen
Med
Reg 1
Gen Med
Reg 2
Trauma
Reg
G/Surg
Reg
Psych
Reg
Ward staff
require medical
staff support!
Request logged
in
Clinical CARPS
Care options Dr task list
Request
automatically
sent to
appropriate Dr
Request
Acknowledge
d
Request
Completed


7. Residents
Registrars
Consultants
Resident
After
Hours
Clinical
Lead
Residents
Registrars
Consultants
Residents
Registrars
Resident
Consultants
Workload
accountability transparency visibility

8. Geographic identifiers allow
streamlining
Nursing identifiers improve
communication
Patient identifiers
prevent errors
Communication

9. Active Management of workload
distribution and response to demand
•Surge Capacity
•Identification of existing redundancy
•Previous system very unbalanced
•Elimination of periods of unsafe workload
–Decreases Resident stress
–Improves efficiency
–Improves response times
–Increased average for some residents well
tolerated

10. Results
No change in:
Hospital mortality
(1.9% vs 1.8%; p-value 0.389)
Median hospital LOS
(3 days vs 3 days)
Number of cardiac arrests
(0.5% vs 0.5%; p-value 0.376).

11. Results
Significant rise in the number of MET calls
(7.2% vs 8.8%; p-value <0.001)
However, after adjusting for confounding
factors, no association was found
(OR 0.9; 95%CI= 0.8-1.0, p-value 0.06)

12. Results
In the patient group that had MET calls
there was a trend to a reduction in mortality
(10.9% vs 9.3%; p-value 0.07).
This trend remained after adjusting for
contributing factors
(OR 0.8; 95%CI= 0.7-1.0; p-value 0.065).

13. A significant decrease was seen in the
hospital length of stay in the patients that had
MET calls
(Median 11 vs 10 days; p-value <0.001)
Results

14. Conclusion
The introduction of the clinical lead role
is associated with a decrease in the
hospital length of stay in the subgroup
of patients that had one or more MET
calls.
There is also a trend to decreased
mortality in this subgroup.