Introduction of an obstetric-specific medical emergency team for obstetric crises: implementation and experience
ABSTRACT We describe the implementation and experience with adding an obstetric-specific medical emergency team (called Condition O for obstetric crisis) to an existing rapid response system at Magee-Womens Hospital.
In response to deficits identified during patient safety review of adverse obstetric events in 2004 and 2005, the hospital administration decided to add a crisis team with expertise specifically designed for maternal and/or fetal crises.
During the first 6 months, staff rarely called Condition O (14 per 10,000 obstetric admissions). After reeducation efforts, use of Condition O increased to 62 per 10,000 obstetric admissions during 2006.
We outline our hospital's experience with implementation, efforts to address low utilization, and 1.5 years of Condition O event data. Condition O is a work in progress. In light of this, we discuss the challenges of measuring its patient safety outcome, considerations for team size and composition, and our efforts to determine an optimal Condition O rate.
- SourceAvailable from: Pei Shan Lim
- "The emergency team is alerted via a paging system simultaneously. In dire emergency such as massive PPH, this system has successfully delivered early interventions hence improving maternal outcomes (Gosman et al., 2008). A delay in intervention of 20 minutes or more had led to a poorer outcome. "
Chapter: Uterine Atony: Management StrategiesBlood Transfusion in Clinical Practice, 03/2012; , ISBN: 978-953-51-0343-1
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- "These systems have now been widely adopted internationally    . They have been extended to cover pediatric     , obstetric   , and emergency department patients [16-19]. Within these systems, nursing and/or medical staff can call an emergency team based on prespecified vital sign abnormalities ( " triggers " ) or because they believe the patient is at risk of a serious adverse event ( " worried " criterion). "
ABSTRACT: The purpose of the study was to examine triggers for emergency team activation in hospitals with or without a medical emergency team (MET) system. Within a cluster randomized controlled trial examining the effect of introducing a MET system, we recorded the triggers for emergency team activation. We compared the proportion and rate of such triggers in hospitals with or without a MET system and in relation to type of hospital, type of patient ward, and time of day. In control hospitals, the most common trigger for emergency team activation was a decrease in Glasgow Coma Score by 2 or more points (45.6%), whereas in MET hospitals, it was the fact that staff members were "worried" or the call occurred despite the lack of a "specified reason" (39.3%). In particular, MET hospitals were 35 times more likely to make a call because of staff being "worried" about the patient (14.1% vs 0.4%, P < .001). Control hospitals were also significantly more likely to call an emergency team because of a deteriorating respiratory (P = .003) or pulse (P < .001) rate, more calls had at least 3 triggers for activation (20.8% vs 10.2%, P = .036), and the average number of triggers per call was significantly higher (P = .013). Nonmetropolitan hospitals were more likely to call an emergency team because of respiratory rate abnormalities (33.6% vs 23.2%, P = .015). Coronary care unit calls were more likely to be triggered by abnormalities in pulse rate and systolic blood pressure, and more calls occurred during the period from 6:00 am to noon. In MET hospitals, more emergency team calls are triggered because staff members are worried about the patient; and fewer calls have multiple triggers. Type of hospital, type of ward, and time of day also affect the nature and frequency of triggers for emergency team activation.Journal of critical care 02/2010; 25(2):359.e1-7. DOI:10.1016/j.jcrc.2009.12.011 · 2.19 Impact Factor
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ABSTRACT: Delay in diagnosis, failure to employ sufficient medical and surgical treatments, and poor teamwork all may contribute to suboptimal outcomes in cases of postpartum hemorrhage. A significant portion of hemorrhage-related maternal morbidity may be prevented through early diagnosis and rapid intervention. There is a small but growing body of literature describing the role of patient safety initiatives and simulation training in optimizing outcomes following postpartum hemorrhage. Rapid response teams may be used to facilitate coordination between various personnel involved in the management of postpartum hemorrhage. Hemorrhage drills and simulation-based training may help providers achieve timely and coordinated responses in the treatment of postpartum hemorrhage. Protocol may help to standardize management in cases of postpartum hemorrhage, thereby minimizing unnecessary errors or delays in care. Additional research is warranted to further determine the impact of patient safety initiatives and simulation training on outcomes in the setting of obstetric hemorrhage.Seminars in perinatology 05/2009; 33(2):104-8. DOI:10.1053/j.semperi.2008.12.002 · 2.42 Impact Factor