Beyond the intensive care unit: A review of interventions aimed at anticipating and preventing in-hospital cardiopulmonary arrest

Naeem, Nauman; Montenegro, Hugo

doi:10.1016/j.resuscitation.2005.04.016

Cited by 52 publications

(25 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is possible that the number of ICU transfers in total was very small. Despite our limited staffing, our results are consistent with those of a meta-analysis of traditional rapid response teams, which found an overall 34% reduction in out-of-ICU cardiac arrests (OR 0.66, 95% CI 0.54–0.80) [16]. …”

Section: Discussionsupporting

confidence: 86%

Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

Blotsky

Mardini

Jayaraman

2016

Critical Care Research and Practice

View full text Add to dashboard Cite

Background. Medical emergency teams (METs) or rapid response teams (RRTs) facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging. Objectives. A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system's impact on time to intervention, code blue rates, and ICU transfer rates. Results. Ninety-five calls were placed for 82 patients. Median time from patient decompensation to intervention was 5 min (IQR 1–10), compared to 3.4 hours (IQR 0.6–12.4) before system implementation (p < 0.001). Total number of ICU admissions from the CTU was reduced from 4.8/1000 patient days (±2.2) before intervention to 3.3/1000 patient days (±1.4) after intervention (IRR: 0.82, p = 0.04 (CI 95%: 0.69–0.99)). CTU code blue rates decreased from 2.2/1000 patient days (±1.6) before intervention to 1.2/1000 patient days (±1.3) after intervention (IRR: 0.51, p = 0.02 (CI 95%: 0.30–0.89)). Conclusion. Our local ward-based response system achieved a significant reduction in the time of patient decompensation to initial intervention, in CTU code blue rates, and in CTU to ICU transfers without necessitating additional usage of financial or human resources.

show abstract

Section: Discussionsupporting

confidence: 86%

Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

Blotsky

Mardini

Jayaraman

2016

Critical Care Research and Practice

View full text Add to dashboard Cite

show abstract

“…Manually assigned vital signs scores designed for this purpose do not have good discrimination either. 29,30 This raises the possibility that, though patient groups may differ in terms of overall illness severity and mortality risk, differences at the individual patient level may be too subtle for clinicians to detect. Future research may thus need to focus on scores that combine laboratory data, vital signs, trends in data, 31,32 and newer proteomic markers (eg, procalcitonin).…”

Section: Discussionmentioning

confidence: 99%

Intra‐hospital transfers to a higher level of care: Contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS)

Escobar¹,

Greene²,

Gardner³

et al. 2010

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:Patients who experience intra‐hospital transfers to a higher level of care (eg, ward to intensive care unit [ICU]) are known to have high mortality. However, these findings have been based on single‐center studies or studies that employ ICU admissions as the denominator.OBJECTIVE:To employ automated bed history data to examine outcomes of intra‐hospital transfers using all hospital admissions as the denominator.DESIGN:Retrospective cohort study.SETTING:A total of 19 acute care hospitals.PATIENTS:A total of 150,495 patients, who experienced 210,470 hospitalizations, admitted to these hospitals between November 1st, 2006 and January 31st, 2008.MEASUREMENTS:Predictors were age, sex, admission type, admission diagnosis, physiologic derangement on admission, and pre‐existing illness burden; outcomes were: 1) occurrence of intra‐hospital transfer, 2) death following admission to the hospital, 3) death following transfer, and 4) total hospital length of stay (LOS).RESULTS:A total of 7,868 hospitalizations that began with admission to either a general medical surgical ward or to a transitional care unit (TCU) had at least one transfer to a higher level of care. These hospitalizations constituted only 3.7% of all admissions, but accounted for 24.2% of all ICU admissions, 21.7% of all hospital deaths, and 13.2% of all hospital days. Models based on age, sex, preadmission laboratory test results, and comorbidities did not predict the occurrence of these transfers.CONCLUSIONS:Patients transferred to higher level of care following admission to the hospital have excess mortality and LOS. Journal of Hospital Medicine 2010;. © 2010 Society of Hospital Medicine.

show abstract

“…There is international concern regarding the management of deteriorating patients, with evidence from the ‘failure to rescue’ literature that up to 80% of cardiac arrests are preventable1 with high levels of physiological disturbance in ward populations, failures in help-seeking behaviour and mismanagement of deterioration leading to poor patient outcomes 1 2. Deterioration indicators are missed in small regional hospitals3 where high-acuity patients may be seen less frequently than in metropolitan settings, leading to skill mix and skill decline concerns.…”

Section: Introductionmentioning

confidence: 99%

Managing patient deterioration: assessing teamwork and individual performance

et al. 2012

View full text Add to dashboard Cite

Despite a satisfactory knowledge base, the application of knowledge was low with notable performance deficits in these demanding and stressful situations. The identification and management of patient deterioration needs to be taught in professional development programmes incorporating high fidelity simulation techniques. The Team Emergency assessment tool proved to be a valid measure of team performance in patient deterioration scenarios.

show abstract

Beyond the intensive care unit: A review of interventions aimed at anticipating and preventing in-hospital cardiopulmonary arrest

Cited by 52 publications

References 53 publications

Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

Intra‐hospital transfers to a higher level of care: Contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS)

Managing patient deterioration: assessing teamwork and individual performance

Contact Info

Product

Resources

About