ANZICS S&Q 2014 - RRT: Alex Psirides on how Wellington resources their RRT
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Alex Psirides talks on how Wellington resources their RRT. Recorded at the ANZICS S&Q Conference 2014: Rapid Response Teams.
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ANZICS S&Q 2014 - RRT: Alex Psirides on how Wellington resources their RRT
- 1. How We Resource Our Rapid Response Team: Wellington, NZ Alex Psirides Intensive Care Specialist @psiridesJuly 2014
- 2. WHO WE ARE: Wellington Regional Hospital Tertiary Regional Hospital - 440 in-patient beds - 18 bed ICU - On-site Children’s Hospital, Neurosurgery, Cardiothoracics, Haem/Oncology, Trauma, ENT, Vascular, Upper GI Surgery, Renal, General Medicine/Surgical, Psychiatric Hospital - Tertiary centre for 9 other hospitals
- 3. OUR RRT: Wellington Regional Hospital • All on-site with 24/7 availability • Respond to emergencies alongside other clinical duties • MET calls led by ICU team & report to ICU Specialist on-call • Governance from ICU SMO & PAR CNS ICU Registrar Patient At Risk Nurse Medical Registrar Medical House Officer
- 4. HOW WE GOT HERE: Patient ‘A’ September 2004: 50 year old man admitted febrile with acute breathlessness & a productive cough. Found dead in bed 2 days later during the morning drug round. &
- 5. HOW WE WORK: EWS/MET Model - Standardised vital signs chart across all in- patient ward areas over 2 sites - EWS based on vital signs - Staged EWS escalation pathway with aggregate, ‘concern’ or single extreme parameter triggered MET call - Adult EWS with variants, PEWS, MEOWS - Family-triggered escalation planned - Paper-based chart system
- 8. WHAT WE COLLECT: Data Sources Data collected from a variety of sources: - Hospital Switchboard Records - Patient At Risk Nurse Database - Reportable Events Registry - MET Case Report Forms Collated monthly & presented to the Clinical Response Committee All CPR is a mandatory reportable event
- 14. OUR MODEL: Strengths Single parameter MET-calling with ability to alter score weighting Successfully established across multiple wards & specialties & integrated into daily workflow Strong multi-disciplinary team with good medical & nursing governance
- 15. OUR MODEL: Weaknesses Ability to alter score weighting Paper based score calculation & data collection Escalation reliant on ward nurses ‘speaking up’ Frequent rotation of medical staff Staff forced to differentiate between MET & Cardiac Arrest MET led by junior staff We may have broken the hospital
Editor's Notes
- Immediate population 1/3 million, regional population 1 million New building opened April 2009 2 hospitals at different sites Don’t do ECMO, spinal injury, burns or plastics
- MET PET MEOWS
- Complaint laid by family member August 2005 to HDC after internal investigation within CCDHB 18 month investigation followed Reviewed by medical team several times without looking at the blood tests or chest X-ray taken in ED. Delayed diagnosis of pneumonia; antibiotics started 28 hours after presentation RR of 60 recorded at one point without escalation What followed was an evisceration of the medical & nursing staff who managed the patient After some delay, EWS established, Patient At Risk nursing team funded & established
- EWS calculated manually 3DHB chart with intent to introduce to other DHBs within New Zealand
- Revised EWS matrix based on the UK NEWS model with the addition of extreme MET calling parameters
- All cardiac arrests are mandatory reportable events so are investigated external to the ward where they happened
- Rates per 1000 admissions
- Annual totals of MET vs cardiac arrest Absolute numbers
- Mean interval between events
- Solar-powered hospital effect
- Hospital mortality has fallen for the last year from 2% to 1.5%
- Calling staff asked to differentiate between MET & cardiac arrest despite same team attending both. Interesting switchboard transcripts where operator asks ‘MET or cardiac arrest?’ <pause> “Hang on, I’ll check” <hangs up> Rings back a minute later - ‘Cardiac arrest”