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.
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ABSTRACT: Medical emergency team (MET) responses have been implemented to reduce inpatient mortality, but data on their efficacy are sparse and there have been no reports to date from US hospitals. To determine how the incidence and outcomes of cardiac arrests have changed following increased use of MET. Objective criteria for MET activation were created and disseminated as part of a crisis management program, after which there was a rapid and sustained increase in the use of MET. A retrospective analysis of clinical outcomes was performed to compare the incidence and mortality of cardiopulmonary arrest before and after the increased use of MET. A retrospective analysis of 3269 MET responses and 1220 cardiopulmonary arrests over 6.8 years showed an increase in MET responses from 13.7 to 25.8 per 1000 admissions (p<0.0001) after instituting objective activation criteria. There was a coincident 17% decrease in the incidence of cardiopulmonary arrests from 6.5 to 5.4 per 1000 admissions (p = 0.016). The proportion of fatal arrests was similar before and after the increase in use of MET. Increased use of MET may be associated with fewer cardiopulmonary arrests.Quality and Safety in Health Care 09/2004; 13(4):251-4. · 2.16 Impact Factor
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ABSTRACT: To determine whether earlier clinical intervention by a medical emergency team prompted by clinical instability in a patient could reduce the incidence of and mortality from unexpected cardiac arrest in hospital. A non-randomised, population based study before (1996) and after (1999) introduction of the medical emergency team. 300 bed tertiary referral teaching hospital. All patients admitted to the hospital in 1996 (n=19 317) and 1999 (n=22 847). Medical emergency team (two doctors and one senior intensive care nurse) attended clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response activated by the bedside nurse or doctor according to predefined criteria. Incidence and outcome of unexpected cardiac arrest. The incidence of unexpected cardiac arrest was 3.77 per 1000 hospital admissions (73 cases) in 1996 (before intervention) and 2.05 per 1000 admissions (47 cases) in 1999 (after intervention), with mortality being 77% (56 patients) and 55% (26 patients), respectively. After adjustment for case mix the intervention was associated with a 50% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.50, 95% confidence interval 0.35 to 0.73). In clinically unstable inpatients early intervention by a medical emergency team significantly reduces the incidence of and mortality from unexpected cardiac arrest in hospital.BMJ (Clinical research ed.). 03/2002; 324(7334):387-90.
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ABSTRACT: To determine: a) the frequency of premonitory signs and symptoms before cardiac arrest in patients on the general medical wards of a hospital; b) any characteristic patterns in nurse and physician responses to these signs and symptoms; and c) whether cardiac arrests on the ward occur more frequently in patients discharged from the medical intensive care unit (ICU) than in other patients. Case series of consecutive patients who had an inhospital cardiac arrest over a 20-month period. General medical wards of a 1,000-bed urban public hospital. There were 21,505 total admissions to the medical service in this period. Patients whose cardiac arrests occurred in the Emergency Room and ICU and patients with do-not-resuscitate orders were excluded from the study. None. There were a total of 150 cardiac arrests on the medical wards (cardiac arrest rate: 7.0/1,000 patients) with a hospital mortality rate of 91%. In 99 of 150 cases, a nurse or physician documented deterioration in the patient's condition within 6 hrs of cardiac arrest. Common findings included: a) failure of the nurse to notify a physician of a deterioration in the patient's mental status; b) failure of the physician to obtain or interpret an arterial blood gas measurement in the setting of respiratory distress; and c) failure of the ICU triage physician to stabilize the patient's condition before transferring the patient to the ICU. Former ICU patients (cardiac arrest rate: 14.7/1,000 patients) were more likely to suffer cardiac arrest than other patients (cardiac arrest rate: 6.8/1,000 patients) (p = .004). Cardiac arrests on the general wards of the hospital are commonly preceded by premonitory signs and symptoms. Strategies to prevent cardiac arrest should include training for nurses and physicians that concentrates on cardiopulmonary stabilization and how to respond to neurologic and respiratory deterioration. Special attention should also be devoted to patients who have been discharged from the ICU who are at greater risk for cardiac arrest after ICU discharge than are other medical patients.Critical Care Medicine 03/1994; 22(2):244-7. · 6.12 Impact Factor