The document discusses rapid response teams (RRTs) which bring critical care expertise to patients whose condition appears to be worsening. It notes that unnecessary deaths still occur in hospitals and RRTs can help address this issue. Data shows that after implementing an RRT at one hospital, cardiac arrests, deaths from cardiac arrest, ICU and hospital stay lengths all decreased. The document provides guidance on setting up an RRT, including engaging leadership, identifying staff roles, establishing alert criteria, training, and evaluating effectiveness. It also discusses tools like the Modified Early Warning Score that can help identify patients needing higher levels of care.
The treatment principles for patients with sepsis are identical regardless of the cause.
Initial assessment and resuscitation should follow the ABCDE format with the application of the
appropriate Sepsis Screening Tool.
Patients should be managed using the Sepsis 6 approach. Liaison with Critical Care should be timely,
particularly in the presence of septic shock or multi-organ failure.
Patients with pneumonia represent the largest group of patients with sepsis.
Common causes of sepsis aside from pneumonia include gastrointestinal pathology, urinary tract,
biliary tract and skin infections.
Sources will vary in the pregnant patient.
Remember to keep an open mind when assessing a patient presenting with sepsis.
The importance of consultation with microbiologists locally who will be aware of pathogens and
resistance patterns in your own institutions cannot be over emphasized.
Most organizations now have their recommended first-line empiric treatments for common infections
on their intranet sites.
A rapid response team (RRT) is dispatched to a patient's bedside when their condition begins deteriorating to prevent cardiac arrest or transfer to the intensive care unit. The RRT consists of physicians and nurses who identify at-risk patients based on changing vital signs. Any staff member can activate the RRT if certain criteria are met, such as abnormal heart rate, respiratory rate, blood pressure, or oxygen levels. The implementation of RRTs in hospitals has been shown to reduce code blue events and unnecessary ICU transfers, thereby saving lives and reducing costs compared to allowing patients to deteriorate to a "code blue" state.
Early warning scores (EWS) are used to facilitate early detection of patient deterioration. The EWS system assigns points to physiological parameters like respiration, oxygen saturation, blood pressure, and temperature to determine a total score. This score dictates the frequency of monitoring and urgency of clinical review. Higher scores indicate more frequent monitoring and quicker medical review are needed. The system aims to standardize recognition of worsening conditions and ensure prompt treatment. Case studies are presented to demonstrate how EWS would be applied in clinical practice.
Patient safety and error reduction approachesLallu Joseph
This document discusses approaches to reducing medical errors and improving patient safety. It begins by defining patient safety and outlining the prevalence of medical errors. It then provides an example of a wrong patient surgery that occurred due to lack of patient identification and unfollowed protocols. The document advocates for a systems approach to error reduction rather than individual discipline. It promotes techniques from human factor engineering like failure mode and effects analysis. Overall, the document argues that senior leadership must support efforts to standardize tasks, reduce handoffs, track performance, and redesign systems to more reliably prevent harm to patients.
The document discusses the Pediatric Early Warning Score (PEWS) system, which is a standardized tool used to assess early clinical deterioration in pediatric patients. PEWS uses parameters like behavior, cardiovascular status, and respiratory status to assign a score that determines the appropriate level of monitoring and care. Higher scores indicate greater risk and require more frequent reassessment and escalation of care, including notification of providers and calling rapid responses. The goal of PEWS is to help clinicians recognize subtle changes in pediatric patients and intervene earlier to prevent cardiac or respiratory arrest.
The document discusses rapid response teams (RRTs) which bring critical care expertise to patients whose condition appears to be worsening. It notes that unnecessary deaths still occur in hospitals and RRTs can help address this issue. Data shows that after implementing an RRT at one hospital, cardiac arrests, deaths from cardiac arrest, ICU and hospital stay lengths all decreased. The document provides guidance on setting up an RRT, including engaging leadership, identifying staff roles, establishing alert criteria, training, and evaluating effectiveness. It also discusses tools like the Modified Early Warning Score that can help identify patients needing higher levels of care.
The treatment principles for patients with sepsis are identical regardless of the cause.
Initial assessment and resuscitation should follow the ABCDE format with the application of the
appropriate Sepsis Screening Tool.
Patients should be managed using the Sepsis 6 approach. Liaison with Critical Care should be timely,
particularly in the presence of septic shock or multi-organ failure.
Patients with pneumonia represent the largest group of patients with sepsis.
Common causes of sepsis aside from pneumonia include gastrointestinal pathology, urinary tract,
biliary tract and skin infections.
Sources will vary in the pregnant patient.
Remember to keep an open mind when assessing a patient presenting with sepsis.
The importance of consultation with microbiologists locally who will be aware of pathogens and
resistance patterns in your own institutions cannot be over emphasized.
Most organizations now have their recommended first-line empiric treatments for common infections
on their intranet sites.
A rapid response team (RRT) is dispatched to a patient's bedside when their condition begins deteriorating to prevent cardiac arrest or transfer to the intensive care unit. The RRT consists of physicians and nurses who identify at-risk patients based on changing vital signs. Any staff member can activate the RRT if certain criteria are met, such as abnormal heart rate, respiratory rate, blood pressure, or oxygen levels. The implementation of RRTs in hospitals has been shown to reduce code blue events and unnecessary ICU transfers, thereby saving lives and reducing costs compared to allowing patients to deteriorate to a "code blue" state.
Early warning scores (EWS) are used to facilitate early detection of patient deterioration. The EWS system assigns points to physiological parameters like respiration, oxygen saturation, blood pressure, and temperature to determine a total score. This score dictates the frequency of monitoring and urgency of clinical review. Higher scores indicate more frequent monitoring and quicker medical review are needed. The system aims to standardize recognition of worsening conditions and ensure prompt treatment. Case studies are presented to demonstrate how EWS would be applied in clinical practice.
Patient safety and error reduction approachesLallu Joseph
This document discusses approaches to reducing medical errors and improving patient safety. It begins by defining patient safety and outlining the prevalence of medical errors. It then provides an example of a wrong patient surgery that occurred due to lack of patient identification and unfollowed protocols. The document advocates for a systems approach to error reduction rather than individual discipline. It promotes techniques from human factor engineering like failure mode and effects analysis. Overall, the document argues that senior leadership must support efforts to standardize tasks, reduce handoffs, track performance, and redesign systems to more reliably prevent harm to patients.
The document discusses the Pediatric Early Warning Score (PEWS) system, which is a standardized tool used to assess early clinical deterioration in pediatric patients. PEWS uses parameters like behavior, cardiovascular status, and respiratory status to assign a score that determines the appropriate level of monitoring and care. Higher scores indicate greater risk and require more frequent reassessment and escalation of care, including notification of providers and calling rapid responses. The goal of PEWS is to help clinicians recognize subtle changes in pediatric patients and intervene earlier to prevent cardiac or respiratory arrest.
Roles of the medical and nursing staff during emergency codesJoven Botin Bilbao
This document outlines the roles and responsibilities of medical and nursing staff during emergency codes and rapid response team activations. It describes:
1) The code blue team which performs resuscitations during cardiopulmonary arrests and includes doctors, nurses, respiratory therapists, and support personnel who must be certified in ACLS, PALS, or NRP.
2) The roles of team members during a code which includes the physician leading the code, nurses maintaining airway/ventilation and administering medications/defibrillation, and respiratory therapists assisting with airway procedures.
3) The rapid response team which provides early intervention to prevent cardiopulmonary arrests and includes ICU nurses, residents, respiratory therapists, and nursing super
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
The document discusses Modified Early Obstetric Warning Scores (MEOWS), which were introduced in the UK to decrease maternal mortality by improving early detection of clinical deterioration in pregnant women. MEOWS involves routinely monitoring and recording vital signs and assigning a score based on abnormalities, with higher scores triggering more urgent review. It is a standardized screening tool used to assist in early recognition of physiological signs of deterioration and intervention for at-risk pregnant women. Regular MEOWS assessments performed by trained midwives can help identify issues earlier before signs worsen and improve outcomes.
To increase the the quality of health care.......... Risk management in labour is vital as it is connected with two lives. So it is the responsibility of the health care providers to assure it.........
The document provides an overview of code management for nurses. It describes what a code is, the roles of the code team including the physician, nurse, and respiratory therapist. It outlines the responsibilities during a code such as initiating CPR, intubation, defibrillation, and administering medications. It also discusses managing the family, criteria for stopping resuscitative efforts, and documentation requirements. The overall document serves as a training guide for nurses on their functions and skills needed during a medical emergency.
The document discusses improving the discharge process at KIMS hospital. It finds that the average discharge times are 3 hours 10 minutes for cash patients, 4 hours 2 minutes for credit patients, and 7 hours for insurance patients. A patient satisfaction survey found 33.5% of patients were under satisfied with the discharge process. The document analyzes the major causes of delay and provides suggestions to standardize processes and reduce discharge times, including having doctors type discharge summaries, centralizing pharmacy clearance, and improving communication between departments through the hospital information management system. Faster discharge times could increase hospital capacity and profitability.
This document outlines new protocols for trauma, environmental, and toxicological emergencies in Rhode Island. It summarizes 24 new protocols which consolidate and replace several previous protocols. The protocols provide guidance for all levels of emergency responders on treatments for injuries such as burns, hypothermia, drowning, and envenomation. They emphasize rapid treatment and transport of critically injured patients.
The document outlines international patient safety goals and guidelines for incident reporting. It discusses 6 main safety goals, including correctly identifying patients, improving communication, and reducing healthcare-associated infections. It also defines different types of incidents like near misses, adverse events, and sentinel events. For reporting, it specifies the immediate actions required and that all incidents must be reported to the quality department within 24 hours. The purpose is to distinguish between different adverse events to improve patient safety.
The document discusses the purpose and definitions related to occurrence variance reporting (OVR) in hospitals. The key points are:
1. The aims of OVR reporting are to positively impact patient care, services, and safety by learning from incidents and preventing future occurrences.
2. Sentinel events are unexpected occurrences that result in death or major loss of function for a patient and are always considered severe adverse events.
3. Mandatory reportable events that require notification within 24 hours include wrong site surgeries, retained surgical items, and transfusion reactions.
4. OVR reports should be written and submitted by the charge person to hospital management within 24 hours of an occurrence. Confidentiality is emphasized
1. The document discusses perioperative mortality and safe anesthesia practices. It defines anesthetic death and classifies the causes of perioperative mortality.
2. Major causes of perioperative mortality include human error, communication failures, equipment failures, and underlying patient diseases. The document provides strategies to prevent complications through improved preoperative assessment, monitoring standards, anesthesia techniques, and postoperative care.
3. In the event of a complication or death, the document stresses the importance of general management practices like monitoring, diagnosis, and treatment, as well as thorough documentation, handling of deceased patients sensitively, and communicating with family members.
Anesthesiologists must ensure patient safety during operations as anesthesia carries risks. Factors threatening safety include equipment issues, patient health conditions, and human factors like fatigue. Strategies to improve safety include thorough preoperative evaluations and planning, situational awareness during procedures, cross-checking observations, preparing for emergencies, enhancing teamwork, and learning from adverse events. Common errors involve airway issues, medication errors, and procedure mistakes, which can be avoided through vigilance, training, and following standards and guidelines. Quality assurance aims to improve care and minimize risks through documentation, safety training, and protocols for monitoring, handoffs, and responding to adverse events.
This document provides information about quality management and occurrence variance reporting (OVR) processes. It defines key terms like quality, adverse events, near misses and sentinel events. It outlines the OVR process which involves any staff member witnessing and reporting an event, investigation by relevant departments, and submission to the continuous quality improvement department for trend analysis. The purpose of OVR is to identify areas for improvement, implement corrective actions, and establish preventative measures through a non-blame approach.
The document provides an overview of an ideal trauma care team structure and roles. It proposes that an ideal trauma care team consists of a team leader, airway specialist, airway assistant, two doctors for assessment and procedures, two nurses for monitoring and circulation, and a scribe. The document outlines the key roles and responsibilities of each member."
The document discusses trauma teams and their roles. It defines a trauma team as a multidisciplinary group that works together to assess and treat severely injured patients. A team approach has been shown to significantly reduce resuscitation times compared to individual doctors. The roles of trauma team members are outlined, as well as techniques for effective communication, briefing, handover, and speaking up if concerns arise. Statistics from Western Australia in 2015 show the most common causes of death for major trauma patients were head injuries and brain death. Overall mortality rates were lower than the national average.
This presentation covers various aspects of OHCA scenarios, including incidence, outcome, challenges, solutions, hen to initiate CPR, protocols, Termination, ECPR, and other issues are covering in details. Explore regional experiences in training and OHCA results as well.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
The document discusses an internship project report submitted to Olive Hospital in Hyderabad on the emergency department and ambulance facility, acknowledging those who provided guidance and an overview of the hospital profile and emergency department facilities, staffing, and medico-legal case processes.
This document outlines an occurrence variance reporting system used by a hospital to systematically identify and address issues that pose safety risks. It defines key terms like occurrences, variances, sentinel events and provides guidelines for reporting, investigating and taking corrective action for different types of incidents. The goal is to use this non-punitive approach to monitor quality, ensure patient and staff safety, and implement improvements through confidential reporting and analysis of issues.
The Housing Task Force met to discuss goals and strategies for redevelopment in the Sharswood/Blumberg neighborhood. They reviewed preliminary goals of consolidating vacant land, redeveloping the Norman Blumberg site at lower density with connected streets, providing infill and mixed-income housing, and developing homeownership opportunities. A market study presented findings on demographics, housing stock, and market rates in the area and broader city. It found support for the initial plan of 57 affordable rental units in Phase I but noted the full plan's market viability would depend on improved conditions attracting residents.
This document summarizes the City's 2015-2019 Consolidated Plan and 2016 Action Plan and Budget for Community Development Block Grant (CDBG) and HOME Investment Partnerships Program (HOME) funds. It provides an overview of funding amounts and sources, eligible activities, goals and objectives, the planning process, and the proposed 2016 budget. Key items in the budget include funding for affordable housing, public services, public facilities, and economic development activities.
Roles of the medical and nursing staff during emergency codesJoven Botin Bilbao
This document outlines the roles and responsibilities of medical and nursing staff during emergency codes and rapid response team activations. It describes:
1) The code blue team which performs resuscitations during cardiopulmonary arrests and includes doctors, nurses, respiratory therapists, and support personnel who must be certified in ACLS, PALS, or NRP.
2) The roles of team members during a code which includes the physician leading the code, nurses maintaining airway/ventilation and administering medications/defibrillation, and respiratory therapists assisting with airway procedures.
3) The rapid response team which provides early intervention to prevent cardiopulmonary arrests and includes ICU nurses, residents, respiratory therapists, and nursing super
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
The document discusses Modified Early Obstetric Warning Scores (MEOWS), which were introduced in the UK to decrease maternal mortality by improving early detection of clinical deterioration in pregnant women. MEOWS involves routinely monitoring and recording vital signs and assigning a score based on abnormalities, with higher scores triggering more urgent review. It is a standardized screening tool used to assist in early recognition of physiological signs of deterioration and intervention for at-risk pregnant women. Regular MEOWS assessments performed by trained midwives can help identify issues earlier before signs worsen and improve outcomes.
To increase the the quality of health care.......... Risk management in labour is vital as it is connected with two lives. So it is the responsibility of the health care providers to assure it.........
The document provides an overview of code management for nurses. It describes what a code is, the roles of the code team including the physician, nurse, and respiratory therapist. It outlines the responsibilities during a code such as initiating CPR, intubation, defibrillation, and administering medications. It also discusses managing the family, criteria for stopping resuscitative efforts, and documentation requirements. The overall document serves as a training guide for nurses on their functions and skills needed during a medical emergency.
The document discusses improving the discharge process at KIMS hospital. It finds that the average discharge times are 3 hours 10 minutes for cash patients, 4 hours 2 minutes for credit patients, and 7 hours for insurance patients. A patient satisfaction survey found 33.5% of patients were under satisfied with the discharge process. The document analyzes the major causes of delay and provides suggestions to standardize processes and reduce discharge times, including having doctors type discharge summaries, centralizing pharmacy clearance, and improving communication between departments through the hospital information management system. Faster discharge times could increase hospital capacity and profitability.
This document outlines new protocols for trauma, environmental, and toxicological emergencies in Rhode Island. It summarizes 24 new protocols which consolidate and replace several previous protocols. The protocols provide guidance for all levels of emergency responders on treatments for injuries such as burns, hypothermia, drowning, and envenomation. They emphasize rapid treatment and transport of critically injured patients.
The document outlines international patient safety goals and guidelines for incident reporting. It discusses 6 main safety goals, including correctly identifying patients, improving communication, and reducing healthcare-associated infections. It also defines different types of incidents like near misses, adverse events, and sentinel events. For reporting, it specifies the immediate actions required and that all incidents must be reported to the quality department within 24 hours. The purpose is to distinguish between different adverse events to improve patient safety.
The document discusses the purpose and definitions related to occurrence variance reporting (OVR) in hospitals. The key points are:
1. The aims of OVR reporting are to positively impact patient care, services, and safety by learning from incidents and preventing future occurrences.
2. Sentinel events are unexpected occurrences that result in death or major loss of function for a patient and are always considered severe adverse events.
3. Mandatory reportable events that require notification within 24 hours include wrong site surgeries, retained surgical items, and transfusion reactions.
4. OVR reports should be written and submitted by the charge person to hospital management within 24 hours of an occurrence. Confidentiality is emphasized
1. The document discusses perioperative mortality and safe anesthesia practices. It defines anesthetic death and classifies the causes of perioperative mortality.
2. Major causes of perioperative mortality include human error, communication failures, equipment failures, and underlying patient diseases. The document provides strategies to prevent complications through improved preoperative assessment, monitoring standards, anesthesia techniques, and postoperative care.
3. In the event of a complication or death, the document stresses the importance of general management practices like monitoring, diagnosis, and treatment, as well as thorough documentation, handling of deceased patients sensitively, and communicating with family members.
Anesthesiologists must ensure patient safety during operations as anesthesia carries risks. Factors threatening safety include equipment issues, patient health conditions, and human factors like fatigue. Strategies to improve safety include thorough preoperative evaluations and planning, situational awareness during procedures, cross-checking observations, preparing for emergencies, enhancing teamwork, and learning from adverse events. Common errors involve airway issues, medication errors, and procedure mistakes, which can be avoided through vigilance, training, and following standards and guidelines. Quality assurance aims to improve care and minimize risks through documentation, safety training, and protocols for monitoring, handoffs, and responding to adverse events.
This document provides information about quality management and occurrence variance reporting (OVR) processes. It defines key terms like quality, adverse events, near misses and sentinel events. It outlines the OVR process which involves any staff member witnessing and reporting an event, investigation by relevant departments, and submission to the continuous quality improvement department for trend analysis. The purpose of OVR is to identify areas for improvement, implement corrective actions, and establish preventative measures through a non-blame approach.
The document provides an overview of an ideal trauma care team structure and roles. It proposes that an ideal trauma care team consists of a team leader, airway specialist, airway assistant, two doctors for assessment and procedures, two nurses for monitoring and circulation, and a scribe. The document outlines the key roles and responsibilities of each member."
The document discusses trauma teams and their roles. It defines a trauma team as a multidisciplinary group that works together to assess and treat severely injured patients. A team approach has been shown to significantly reduce resuscitation times compared to individual doctors. The roles of trauma team members are outlined, as well as techniques for effective communication, briefing, handover, and speaking up if concerns arise. Statistics from Western Australia in 2015 show the most common causes of death for major trauma patients were head injuries and brain death. Overall mortality rates were lower than the national average.
This presentation covers various aspects of OHCA scenarios, including incidence, outcome, challenges, solutions, hen to initiate CPR, protocols, Termination, ECPR, and other issues are covering in details. Explore regional experiences in training and OHCA results as well.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
The document discusses an internship project report submitted to Olive Hospital in Hyderabad on the emergency department and ambulance facility, acknowledging those who provided guidance and an overview of the hospital profile and emergency department facilities, staffing, and medico-legal case processes.
This document outlines an occurrence variance reporting system used by a hospital to systematically identify and address issues that pose safety risks. It defines key terms like occurrences, variances, sentinel events and provides guidelines for reporting, investigating and taking corrective action for different types of incidents. The goal is to use this non-punitive approach to monitor quality, ensure patient and staff safety, and implement improvements through confidential reporting and analysis of issues.
The Housing Task Force met to discuss goals and strategies for redevelopment in the Sharswood/Blumberg neighborhood. They reviewed preliminary goals of consolidating vacant land, redeveloping the Norman Blumberg site at lower density with connected streets, providing infill and mixed-income housing, and developing homeownership opportunities. A market study presented findings on demographics, housing stock, and market rates in the area and broader city. It found support for the initial plan of 57 affordable rental units in Phase I but noted the full plan's market viability would depend on improved conditions attracting residents.
This document summarizes the City's 2015-2019 Consolidated Plan and 2016 Action Plan and Budget for Community Development Block Grant (CDBG) and HOME Investment Partnerships Program (HOME) funds. It provides an overview of funding amounts and sources, eligible activities, goals and objectives, the planning process, and the proposed 2016 budget. Key items in the budget include funding for affordable housing, public services, public facilities, and economic development activities.
The document discusses monitoring and evaluation mechanisms for development projects in Malaysia. It introduces the Implementation Coordination Unit (ICU) and its role in managing and monitoring development projects. It outlines ICU's monitoring initiatives and machinery, including its project monitoring system called SPP II. The document emphasizes the importance of outcome-based approaches and monitoring outcomes rather than just outputs to evaluate effectiveness. It also discusses challenges with current monitoring practices and the need to transform to more results-based frameworks.
What can a Clinical Nurse Leader do for your critical care nursing unit? Plenty! Consider this new nursing role as one that can improve patient outcomes and increase satisfaction for both clients and staff. Successful microsystems begin with empowering patients, families and front line nurses.
This document discusses purposeful rounding and interdisciplinary rounds in the intensive care unit (ICU). It provides an example of a typical daily routine at Dunedin Hospital ICU, which includes a morning ward round and walk around rounds. The presentation notes some areas for improvement, such as developing a more structured handover process and checklist for nurses. It also explores whether purposeful rounding could benefit the ICU as it has been shown to reduce falls, pressure ulcers, and improve patient satisfaction in other ward settings, though more evidence may still be needed specific to ICUs.
251109 rm-m.r.-data collection methods in quantitative research-an overviewVivek Vasan
The document discusses different methods for collecting quantitative data in research, including structured questionnaires, interviews, observation, and biophysiologic measures. It describes key dimensions to consider like structure, quantifiability, researcher obtrusiveness, and objectivity. The major sections explain self-reports, observation techniques, and collecting biophysiologic data like vital signs measurements.
There are various methods for collecting primary and secondary data. Primary data collection methods include observation, interviews, questionnaires, and schedules. Secondary data refers to previously collected data that is analyzed and available for use in other studies. Factors to consider when selecting a data collection method include the nature, scope, and objective of the research, available funds and time, and required precision.
This document outlines a proposal to implement a rapid response team (RRT) at an urban Magnet hospital to improve patient outcomes on medical and surgical units. The purpose is to determine if an RRT can reduce hospital stays, decrease transfers to higher levels of care, and increase patient functionality at discharge. The proposal describes the background on RRTs, significance to nursing practice, literature review on clinical outcomes, relevant nursing theories, and the Iowa Model framework. It provides details on the methodology, team development and training, communication systems, education, documentation, and implementation process including activation protocols and safety huddles. The goal is to activate the RRT for at-risk patients showing signs of respiratory distress, changes in mental status, abnormal
ANZICS S&Q 2014 - RRT: Anna Green on Western Health Resourcing RRTsANZICS
The document discusses the rapid response team (RRT) at Western Health in Victoria. It outlines the criteria for clinical reviews, rapid response calls, and code blue calls for deteriorating patients. It describes the RRT at Western and Sunshine Hospitals, which is nurse-led from 8am to 6:30pm daily. The ICU Liaison Nurse's role includes assessing patients prior to ICU discharge, following up ICU patients at risk, responding to rapid response calls, and daily rounding in clinical areas. Data shows rounding in new areas and the RRT have reduced unplanned ICU admissions and post-ICU mortality.
Challenges and improvements in diagnostic services across seven day services NHS Improving Quality
Prof Erika Denton, National Clinical Director for Diagnostics. Slides from Erika's presentation at the 7 Day services events in West Midlands 11th June and East Midlands 12th June, 2014.
Public Health HIV/STD Control in the US in the Era of TASP: 90-90-90 and Beyond
Matthew Golden, MD, MPH
February 2nd, 2018
UCSD HIV & Global Health Rounds
Dr Derek Thompson: Building a caring futureNuffield Trust
In this slideshow, Dr Derek Thompson, GP and Medical Director at Northumbria Healthcare Foundation Trust, on reducing the length of hospital stay and building a caring future.
Dr Thompson spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
Our presentation at AMIA about our regional MRSA collaborative and use of health information technology to share MRSA colonization and infection data electronically.
This document discusses NSW Health policy and strategies around managing elective surgery waiting lists from the NSW perspective. It provides an overview of the NSW elective surgery access performance targets, principles of waiting list management in NSW, current performance statistics, and statewide and local strategies to improve and maintain performance. Key points include the development of a policy in 2006 to address long wait times, current performance exceeding targets, and efforts across districts/networks like capacity planning and purchasing private provider activity to optimize patient access to surgery.
Implementing Physician Assistants in the ED to improve patient experience Criterion Conferences
• Supporting doctors to help expedite patient care
• Ensuring high quality and timely care
• Examining effectiveness one year on
Benjamin Close Director Emergency Townsville Hospital, QLD
- 35% of non-elective hospital admissions in the UK are concentrated in just 1% of the population, who are highly transient and in need of proactive support.
- A proactive health coaching intervention aims to circumvent periods of high healthcare utilization by providing non-clinical support to empower patients and improve self-management, especially at the earliest signs of disease progression.
- Initial results found the intervention led to fewer hospital admissions and emergency department visits, shorter hospital stays, better health outcomes, and higher quality of life for patients.
Health Navigator lunch and learn – 15 January 2016Rebecca Wootton
- 35% of non-elective hospital admissions in the UK are concentrated in just 1% of the population, who are highly transient and in need of proactive support.
- A proactive health coaching intervention aims to circumvent periods of high healthcare utilization by providing non-clinical support to empower patients and improve self-management from the earliest signs of disease progression.
- Initial results found the intervention led to fewer emergency admissions and hospital bed days, reduced healthcare costs, and improved patient health outcomes and quality of life.
The document summarizes the Acute Care Team (ACT) at Warrington Hospital, which received an award in 2015 for acute care innovation. The ACT is a multi-professional team that provides 24/7 rapid response to deteriorating patients. It aims to improve outcomes by detecting deterioration earlier, preventing serious events, and providing end of life care. Since implementing the ACT, Warrington Hospital has seen reductions in mortality, cardiac arrests, and unplanned ICU admissions and deaths. The ACT serves as a model for acute care that can be replicated across the NHS.
The Deteriorating Patient and National Early Warning Score (NEWS) programme, marks the two year anniversary of the launch of the West of England Patient Safety Collaborative. These slides focus on celebrating our impact and demonstrable results across the region.
TYA and Adult Late Effects Service at UCLHUCLPartners
Presentation by Victoria Grandage of University College London Hospitals NHS Foundation Trust at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
For more information contact: Slideshare@marcusevans.com
Presentation delivered by Donna Medina, Regional Director,OSF Hospice and Homecare Foundation at the marcus evans Home Care Leadership Summit held on July 13 & 14 2015 in Palm Beach FL.
Oct 23 CAPHC CPDSN Symposium - Dr. Peter FitzgeraldGlenna Gosewich
This document discusses data analytics in healthcare. It provides examples of how hospitals are using data to improve care and reduce costs. One hospital, MCH, analyzed its data to determine its pediatric emergency department had an unsustainably high admission rate of 10.1%, above the Canadian average of 8.1%. MCH set a goal to reduce its admission rate to the average and took steps like expanding its wait at home practice and partnering with specialty teams and community providers to improve discharge processes and provide more upstream care in the community.
This document discusses data analytics in healthcare. It provides examples of how hospitals are using data to improve care and reduce costs. One hospital, MCH, analyzed its data to determine its pediatric emergency department had an unsustainably high admission rate of 10.1%, above the Canadian average of 8.1%. MCH set a goal to reduce its admission rate to the average and took steps like expanding its wait at home practice and partnering with specialty teams and community providers to improve discharge processes and provide more upstream care in the community.
ANZICS S&Q 2014 - RRT: Robert Herkes on why ward staff should manage their ow...ANZICS
Robert Herkes makes the argument that ward staff should manage their own deteriorating patients. Presented at the ANZICS S&Q Conference 2014 on Rapid Response Teams.
ANZICS S&Q 2014 - RRT: Owen Roodenburg on educating and supporting JMOsANZICS
Owen Roodenburg discusses how the Alfred Hospital educates and supports JMOs to run MET calls. Presented at the ANZICS S&Q Conference 2014 on Rapid Response Teams.
ANZICS S&Q 2014 - RRT: Daryl Jones on integration of hospital careANZICS
This document summarizes strategies to improve management of deteriorating hospital patients. It discusses (1) establishing governance committees to oversee policies, (2) classifying rapid response team (RRT) calls to identify patterns and improve care, and (3) implementing programs to detect and manage deterioration earlier such as teaching junior doctors to conduct urgent clinical reviews, referring patients to palliative care, and placing an ICU fellow on high-risk surgical wards. The goals are to reduce RRT calls and prevent cardiac arrests by taking a more proactive approach to managing deterioration.
ANZICS S&Q 2014 - RRT: Ken Hillman presenting that ICU should triage & assess...ANZICS
Ken Hillman presenting that ICU should triage & assess all deteriorating ward patients. Presented at the ANZICS S&Q Conference 2014 on Rapid Response Teams.
ANZICS S&Q 2014 - RRT: John Santamaria on RRT Crises and accountability from ...ANZICS
John Santamaria on RRT Crises and accountability from an ICU directors perspective. Presented at the ANZICS S&Q Conference 2014 on Rapid Response Teams.
ANZICS S&Q 2014 - RRT: Michelle Topple on the Austin MET Nurse programANZICS
The document provides an overview of the MET Nurse Program at Austin Health, a major tertiary health provider in Melbourne. It describes the roles and responsibilities of MET nurses, which include attending emergency calls, assessing and assisting with deteriorating patients, educating other staff, and working in the ICU. The MET Panel oversees the program and ensures a high quality of care. The program trains ICU nurses to become accredited MET nurses over the course of 6 months through lectures, workshops and supervised calls. So far 75 nurses have graduated from the program, helping to improve outcomes for deteriorating patients across the health service.
ANZICS S&Q 2014 - Abstract Presentation: Jamie Mann-Farrar - From frying pan ...ANZICS
Jamie Mann-Farrar presents findings from a study asking whether adverse events and clinical incidents are associated with MET responders leaving clinical duties. Recorded at the ANZICS S&Q 2014: Rapid Response Teams.
ANZICS S&Q 2014 - Abstract Presentation: Considine on outcomes of RRT patient...ANZICS
This study examined outcomes of patients who experienced clinical deterioration requiring an emergency response within 24 hours or after 24 hours of emergency admission to medical or surgical wards. The study found that 28.4% of patients experienced deterioration within 24 hours of admission, who had lower rates of recurrent emergency responses, ICU admissions, and shorter hospital lengths of stay, compared to those whose deterioration occurred after 24 hours. Over half of all emergency responses on medical and surgical units during the study period were for patients admitted through the emergency department. Further research is needed to understand factors contributing to early clinical deterioration in patients admitted via the emergency department.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
ANZICS S&Q 2014 - Abstract Presentation: Joanne Molloy on How time of day for a rapid response call affect patient outcomes
1. CRITICAL CARE LIAISON NURSE SERVICE
Timing of Rapid Response
Team Activations and
Patient Outcomes
Joanne Molloy
RN BN Grad Dip-ICU, Grad Dip Training & Development, MN(Nurse Pract)
Naomi Pratt
RN BN Grad Cert-ICU, MN(Nurse Pract)
3. CRITICAL CARE LIAISON NURSE SERVICE
CCLN Service
• The service commended in 2009 and has expanded greatly over the
past 5 years:
– 810 patients seen in first 12 months of service
– 1736 patients in 2013
• The main referral sources to the service:
– ICU patients discharged to the general wards
– Rapid Response Calls
– Direct referrals of high risk and deteriorating patients
• >2000 RRCs attended, coordinated & managed by each of CCLN
CNCs during service hours.
• Leadership in data management, review and reporting of RRC events.
4. CRITICAL CARE LIAISON NURSE SERVICE
Literature
• 53% of RRC occurred between 1800-0800. (Jones,
2005)
• RRT activations were more common during the day
(The Medical Emergency Team End-of-Life Care
investigators., 2013)
• In-hospital cardiac arrests survival rates were
substantially lower out of office hours. (Peberdy et al.,
2008)
• Higher rate of negative outcomes for patients who
triggered a RRT call-out at night. (Morris et al., 2013)
5. CRITICAL CARE LIAISON NURSE SERVICE
Objective
The objective of this research project was to
investigate the hypothesis that the patients who
have had rapid response calls (RRC) during the
day time have better outcomes.
6. CRITICAL CARE LIAISON NURSE SERVICE
Method
• Approval for this project was obtained from the
Peninsula Health Human Research and Ethics
Committee.
• A retrospective review of RRCs during 2012 was
conducted using existing hospital databases.
• The RRCs that occurred from 0800 – 1759 were
considered “in-hours” and those that happened
1800-0759 were “out-of-hours”.
7. CRITICAL CARE LIAISON NURSE SERVICE
Patient Population
• Inclusion criteria:
RRC on admitted adult inpatients > 18 years of age at
Frankston Hospital during 2012
• Exclusion criteria:
RRC made for adult patients located within the ICU or
emergency department
8. CRITICAL CARE LIAISON NURSE SERVICE
Intervention
• Events were classified as a MET or Respond
Blue based upon the interventions performed by
the RRC team.
• Respond Blue classification:
cardiopulmonary arrest
chest compression
defibrillation
advanced airway support +/- endo-tracheal intubation
9. CRITICAL CARE LIAISON NURSE SERVICE
Data Collection
• The data collected included:
Patient demographics,
Date and time of the RRC,
Outcomes immediately after the RRC, at 24 hours and
hospital separation (death, discharge and transfer)
• Additional data for patients admitted to ICU
included:
Acute Physiology and Chronic Health Evaluation (APACHE)
III score
ICU length of stay (LOS)
Death in ICU
10. CRITICAL CARE LIAISON NURSE SERVICE
Results
Total RRCs
892
In hours
537
MET
510
Blue
27
Out of hours
355
MET
325
Blue
30
11. CRITICAL CARE LIAISON NURSE SERVICE
Patient Characteristics
In-hours Out-of-hours
Number of RRCs 537 (60.2%) 355 (39.8%)
Age (SD) 70.80 (17.9) 70.04 (17.9)
Sex % Male 247 (46%) 175 (49%)
Admitting Unit:
Medical 337 (62.7%) 231 (65.1%)
Surgical 166 (30.9%) 96 (27.0%)
Mental Health 25 (10.2%) 16 (4.5%)
Obstetrics 8 (1.5%) 11 (3.1%)
12. CRITICAL CARE LIAISON NURSE SERVICE
0
25
50
75
0:00
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
22:00
23:00
RRCs distribution
In hours
Out of hours
Straight black line = 37 average expected calls over 24-hour period
13. CRITICAL CARE LIAISON NURSE SERVICE
Respond Blues
In-hours
(n=537)
Out-of-hours
(n=355)
ρ Values
27/537 (5.0%) 30/355 (8.4%) ρ < 0.05
14. CRITICAL CARE LIAISON NURSE SERVICE
ICU Admissions
In-hours
(n=537)
Out-of-hours
(n=355)
Immediate 66/537 (12.3%) 69/355 (19.4%)
24 hours post 75/537 (14.0%) 73/355 (20.6%)
APACHE III
Mean (SD)
18.17 (6.67) 18.38 (6.56)
ICU LOS
Mean (SD)
6.09 (9.56) 4.43 (5.82)
15. CRITICAL CARE LIAISON NURSE SERVICE
RRC Mortality
In-hours
(n=537)
Out-of-hours
(n=355)
Immediate 7/537 (1.3%) 19/355 (5.4%)
24 hours post 35/537 (6%) 35/355 (9.9%)
Hospital
Mortality
134/537 (25%) 155/355 (35.5%)
16. CRITICAL CARE LIAISON NURSE SERVICE
Discussion
• Less observation and direct patient care
• Less staff both nursing, medical and allied
health
• Less skilled practitioners, both those calling
the RRC and those responding i.e..
consultants, specialist teams, CCLNs etc.
• Detection of deterioration may delayed or not
detected at all
17. CRITICAL CARE LIAISON NURSE SERVICE
Conclusion
• Patients experiencing an out-of-hours RRC were more likely
to have a Code Blue call, have unplanned ICU admissions
and were associated with higher mortality rates at all
outcome points.
• This has significant implications for patient mortality and
morbidity
The next step:
• A prospective study looking in greater detail at patient
acuity at time of RRC and the actions of the responders
during the RRC.
Editor's Notes
We will present the
Background to our study and some of the relevant literature.
We present our objective, methods and results.
And then discuss this findings and our conclusions.
Frankston Hospital has 336 beds which services a population of 300K, which can increase by a 100K over the summer holiday period.
Greater than average population over the age of 65 with 21% (state average 14%)
It does no provide cardiac surgery, neurosurgery or major trauma service.
The ED is one of the states busiest, with close to 60 000 Presenations.
Frankston Hospital Intensive Care Unit (ICU) is a 15-bed Level-III ICU with capacity for 9 ICU equivalent. There were over 1100 admissions in 2013.
The CCLN service at Peninsula health was first established in 2009 and has developed and expanded over the past 5 years.
The CCLN team provides a consistent service bring corporate knowledge to the bedside with an understanding of the hospital and ward environments including identifying the best environment for deteriorating patients within the organisation.
We work and communicate across all skill levels from graduates to consultants.
At PH the medical emergency team or MET and respond blue teams answers calls made by frontline medical and nursing staff in response to clinical triggers. The team comprises of a senior ICU and medical registrar and Critical care trained nurse.
The CCLN attends the RRC during their service hours and provides clinical leadership. As a result over the past 5 years, Naomi and I have attended, coordinated and managed > 2000 RRCs between us.
We have also responsible for maintaining the RRC database, monthly quality reporting and the identification of cases for review.
While routinely evaluating our RRS data at PH, we observed differences between patient outcomes out-of-hours
With this in mind we went looking for current research evidence and found limited studies looking at the variability of patient outcomes according to time of day
After we received ethics approval, we conducted a retrospective review of RRCs during 2012 using existing hospital databases.
RRC data is collected at the time of the RRC by clinicians attending the event using a duplicate form. A master log is maintained and this data is entered into an ACCESS database. We also used other hospital databases including ipm and the ICU ANZICS database.
The RRCs that occurred from 0800 – 1759 were considered “in-hours” and those that happened 1800-0759 were “out-of-hours”.
These inclusion/exclusion criteria and events classification were used to match patient population characteristics of other published RRC studies.
Advanced airway support included use of oral-pharyngeal or naso-pharyngael airways and the use of a bag-valve mask circuit.
Using a customised data collection form, and entered into an excel spread sheet.
This was then analysed using statistics software by Dr Ravi Tiruvoipati, using students t-test and chai square to obtain results.
Total of 892 calls that met the inclusion/exclusion criteria.
60% occurred during in-hours which represents only 40% of the 24 hours
So we can already see an uneven distribution of RRC throughout the 24 hrs. which is demonstrated in a later graph.
Two groups are quite homogenous in regards to age, sex and admitting unit
There was no statistical significance btw the groups
Activation of RRC was not uniform over the 24 hour cycle.
The average hourly activation of RRC was 37 calls per hour over the 24 hr period for the 12months.
We found that a total of 60% of the RRC occurred during daylight hours.
This coincides with findings published this year 2013 by the “MET end of life care investigator’s” who collected data on all RRC calls in 1 month during 2009 from 7 different institutions (Australia, Canada and Sweden) who also found a peaks first thing in the morning, with RRC less common overnight.
REFERENCE
There were 57 blues during 2012 with 47% in-hours and 53% occurring out-of-hours
There was a significant difference in this with the increased likelihood that a RRC which occured out of hours would be a BLUE this achieved a p value of < 0.05
From the 892 RRCs in 2012, 135 patients transferred to ICU immediately after RRC – 12.3% in hours – and 19.4% out of hours. You were more likely to be require transfer to ICU either immediately or within the first 24hrs after a RRC if your call occurred out-of-hours.
Overall if you had a RRC out of hours you were more likely to be transferred to ICU with 20% of RRC transferred to ICU.
There was no significant differences noted between APACHE, ICU LOS or ICU mortality between the two groups. This may be due to the sample size.
Mortality ICU – Not significant between two groups – however trend towards higher in out of hours group with 23% dying in ICU and 16% in hour did not reach significance –likely due to sample size.
The results from our analysis demonstrated that the RRC that occurred out-of-hours were associated with a significantly worse mortality rate – This was significant irrespective of the time point used for analysis – with significant difference both immediately, at 24hr and whether the patient survived to hospital discharge.
Hospital LOS – Mean – In hours – 15.65 days, out of hours – 16.00 days
Combined data for all RRC during 2012
Overall mortality rate of 32.4% Immediate mortality rate – 3%, 24hr – 7.8%
Hospital mortality rate at Frankston Hospital is close to 2%
Looking at our results – What is different out-of-hours?
Are the patients different? Our data showed a homogenous patient group
Vital signs spaced more widely overnight – peak levels of cardiac arrest detection corresponded to overnight nursing routine
Not just less staff itself, tend to be covering staff – staff not familiar with the patient
Characteristics of RRC team
Delayed MET activation has been independently associated with greater risk of unplanned ICU admissions and hospital mortality (Calzavacca et al., 2010)
Delayed activation of MET team strongest independent predictor in mortality of patients receiving a RRT review (Calzavacca et al., 2008)
Out of hours RRC – found to have higher mortality rate at all outcome points, more likely to be a Code Blue call, and be admitted to ICU.
Staffing and resource allocation should be reviewed in the light of these findings.
Utilisation of high acuity or observing areas (HDU/ICU)
As well as skill level of both the activator and responder