Improving Outcomes by Crisis Team

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Improving Outcomes by Crisis Team

• University of Pittsburgh Medical Center

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Emergencies in the Hospital
Unrecognized clinical deterioration or inadequate
response result in cardio respiratory arrests
and increased mortality/morbidity

• Why do patients die on general wards after
  discharge from the intensive care units?
• C.B.Wallis et al. Anesthesia 1997
• Recognizing clinical instability in hospital
  patients before cardiac arrest or unplanned
  admission to intensive care.
• MD Buist et al. Medical Journal of Australia
  1999
• Effects of medical emergency team on reduction of
  incidence of and mortality from unexpected
  cardiac arrests in hospital preliminary study
• MD Buist et al BMJ 2002
• Antecedents to hospital deaths.
• Hillman at al. Intern Med J 2001

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Crisis Management Team(Condition C) UPMC
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Condition C team

• Team leader ICU physician
• Airway manager Anesthesia/Critical care
• Respiratory Care Airway assistant
• 2 physicians procedures and cardiac compressions
• 2 ICU nurses medications/equipment/record
• Bedside nurse help ICU nurses

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Condition C Criteria

• Respiratory
• Rate lt8 or 36 /min
• New onset difficulty breathing
• New pulse oximeter reading
• lt85 for gt than 5 minutes (unless patient known
  to have chronic hypoxemia)

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Condition C criteria

• Cardiac
• Heart rate lt40 or 140/ minute with new symptoms
  or gt160/minute
• Blood pressure lt80 or gt200 mm of Hg systolic or
  110 mm of Hg diastolic with symptoms (neurologic
  change, chest pain, difficulty
  breathing)

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Condition C criteria

• Neurologic
• Acute loss of consciousness
• New onset of lethargy or difficulty waking
• Sudden collapse
• Seizure (outside seizure monitoring unit)
• Sudden loss of movement (or weakness) of face,
  arm or leg

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Condition C criteria

• Other
• More than 1 STAT page needed to assemble team
  needed to respond to the crisis.
• Patient complaint of cardiac chest pain
  unresponsive to Nitroglycerin or Physician
  unavailable
• Color change of patient or extremity pale,
  dusky,blue or gray
• Unexplained agitation for gt10 minutes
• Suicide attempt
• Uncontrolled bleeding/bleeding in to airway
• Narcan use without immediate response

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Results
Per 1000 admissions
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Why did the new system work?

• Leadership
• Multidisciplinary participation
• Defined criteria
• Responsibility of team members well defined
• Availability of Standardized Equipment Cart
• Feed back and encouragement by managers to use
  the team