John Santamaria on what KPIs should we measure for RRTs. Presented at the ANZICS S&Q Conference 2014 on Rapid Response Teams.

1. What Key Performance
Indicators Should We
Measure?
John Santamaria

2. Introduction
• MERIT Study – what hypotheses
• Cardiac arrests
• Hospital mortality
• Unexpected admission to ICU

3. Introduction
• Need for a bi-national MET Database
• Why should we measure activity
• Provide a benchmark? or
• Opportunity to look at trends, patterns
Implement changes

4. MET Database
• Minimum dataset (who collects?)
• Demographics
• Calling criteria
• Cause of call – MET syndrome
• Call & patient outcome

5. Process Indicators

6. Why collect process data?
• Justify our existence or additional staff
• Monitoring care within the hospital?
• Monitoring outcome of new systems?
• NEAT?

7. ACHS Clinical Indicators

8. Calls
• July – Dec 2013
• 401 calls on inpatients
• 9 calls on outpatients
• 27 calls on visitors
• 3 calls on staff members

9. Calling Rates
• Activity of the Service (calls/1000 patients)
• Referenced to the patient population
• Acute care, palliative care, rehabilitation
• Definition of which calls to include

10. Hospital Activity
All Patients Acute
Patients
1 + day Multi-day
Jul-Dec 2013 29193 26900 10400 6722
Calls 401 401 401 401
Calling Rate 13.74 14.91 38.56 59.65
Calling rate from 14-60/1000 admissions !

11. Hospital Activity
Crit Care Med 2010:38:445

12. Other Process Indicators
• Calls (/1000) within 24 hours of admission
• Calls (/100) patients discharged ICU < 72 hours
• Calls (/1000) within 24 hours of procedure
• Unexpected admissions to ICU (??)

13. Nature of Calls
• Proportion/Number calls for individual criteria
• Duration of calls (median)
• Proportion/Number of MET syndromes
• Proportion/Number of calls where advanced
therapies needed (CVC, intubation)

14. Outcomes of Calls
• MERIT outcomes
Resolved, Death (CPR ceased), Stable rhythm,
Further Rx required,
• Percentage Transfer to specialty areas
ICU, CCU, Imaging, Theatre, ED

15. Patient Outcomes
• Cardiac arrests / (1000) admissions
• Hospital mortality / (1000) admissions
• Hospital mortality / (1000) admissions with no
treatment limitation

16. Delayed Activation
• Electronic medical records with observations
• Ward by ward audits
Patients meeting MET or Urgent Review
calls/patients on ward during audit

17. Limitation of Medical Rx
• Percentage of calls on patients with valid LMTO
(all calls or only first call)
• Percentage of calls on patients where a new LMTO
was made

18. Summary
• Need assistance with collection/entry of data
• Need a minimum dataset and central repository
• Need agreed definitions of which calls, and which
patients to define the rates
• Need good audit/research of such data