OUR LADY OF LOURDES OUR LADY OF LOURDES MEMORIAL HOSPITALMEMORIAL HOSPITALBinghamton, New YorkBinghamton, New York

MMedical edical EEmergency mergency TTeameamMETMET

A Strategy to Reduce A Strategy to Reduce Morbidity and MortalityMorbidity and Mortality

Our Lady of Lourdes Our Lady of Lourdes Memorial HospitalMemorial Hospital

Our Lady of Lourdes Hospital is a 267 bed Our Lady of Lourdes Hospital is a 267 bed acute care, community, not-for-profit acute care, community, not-for-profit healthcare facility which provides a full healthcare facility which provides a full spectrum of inpatient, ambulatory and spectrum of inpatient, ambulatory and emergency services. emergency services.

MMedical edical EEmergency mergency TTeameam

PURPOSE:PURPOSE:

The Medical Emergency Team is The Medical Emergency Team is available to provide consultation and available to provide consultation and assistance to non-critical care nursing assistance to non-critical care nursing staff in the identification and triage of staff in the identification and triage of potentially life threatening conditions.potentially life threatening conditions.

MMedical edical EEmergency mergency TTeameam

Cardiac arrests in hospitals are usually Cardiac arrests in hospitals are usually preceded by signs of clinical instability that preceded by signs of clinical instability that typically begin 6-8 hours prior to arrest.typically begin 6-8 hours prior to arrest.

Risk of death with in-hospital Risk of death with in-hospital cardiopulmonary arrest is reported in the cardiopulmonary arrest is reported in the literature as between 50% and 80%.literature as between 50% and 80%.

MMedical edical EEmergency mergency TTeameam

MET Members:MET Members:

ACLS RN (ICU – 1st Responder. If unable to ACLS RN (ICU – 1st Responder. If unable to respond, ICU RN will call ER or Seton 1 respond, ICU RN will call ER or Seton 1 Telemetry)Telemetry)

Respiratory TherapistRespiratory Therapist Clinical ManagerClinical Manager Primary Registered Nurse on patient unitPrimary Registered Nurse on patient unit

MET responds with a Life-PakMET responds with a Life-Pak

MMedical edical EEmergency mergency TTeameam

CRITERIA:CRITERIA:

HAVE A CONCERN-HAVE A CONCERN- Something’s just not right Something’s just not right

Acute symptomatic change in respirations, respiratory Acute symptomatic change in respirations, respiratory

distress or threatened airway (<8 or >30) distress or threatened airway (<8 or >30) OROR Change in Change in

breathing patternbreathing pattern

Acute symptomatic change in heart rate(<40 or >130), Acute symptomatic change in heart rate(<40 or >130),

refer to baselinerefer to baseline

Acute change in oxygen saturation, <90% despite oxygenAcute change in oxygen saturation, <90% despite oxygen

MMedical edical EEmergency mergency TTeameam

Acute symptomatic change in blood pressure, refer to Acute symptomatic change in blood pressure, refer to

baselinebaseline

Chest painChest pain

Acute change in level of consciousness (LOC)Acute change in level of consciousness (LOC)

Decrease in urinary output; <50 ml in 4 hours without Decrease in urinary output; <50 ml in 4 hours without

history of renal dysfunctionhistory of renal dysfunction

Failure to respond to treatmentFailure to respond to treatment

New, repeated or prolonged seizureNew, repeated or prolonged seizure

Our Process to Initiate METOur Process to Initiate MET

Call is placed to ICU, stating “This is a Call is placed to ICU, stating “This is a MET call”.MET call”.

ICU RN gets brief overview of reason for ICU RN gets brief overview of reason for call.call.

ICU pages Respiratory Therapist to make ICU pages Respiratory Therapist to make them aware of MET call and location.them aware of MET call and location.

If ICU RN unable to respond, Telemetry If ICU RN unable to respond, Telemetry Unit is notified. If Telemetry Unit RN is Unit is notified. If Telemetry Unit RN is unable to respond, ICU RN notifies unable to respond, ICU RN notifies Emergency Department RN to respond.Emergency Department RN to respond.

SBAR CommunicationSBAR Communication

S – SituationS – Situation

B – BackgroundB – Background

A – AssessmentA – Assessment

R - RecommendationR - Recommendation

SBARSBAR

Definition:Definition: SBAR is a situational briefing tool that SBAR is a situational briefing tool that

logically organizes information so that logically organizes information so that it can be transferred to others in an it can be transferred to others in an accurate and efficient manner.accurate and efficient manner.

SBARSBAR

Fosters critical thinking skillsFosters critical thinking skills

Eliminates information getting lost in translationEliminates information getting lost in translation

Saves timeSaves time

Develops RN / RT assertive behaviorDevelops RN / RT assertive behavior Individuals speaking up and stating their Individuals speaking up and stating their

information with appropriate persistence until information with appropriate persistence until there is a resolution, all done in the interest of there is a resolution, all done in the interest of better patient carebetter patient care

SBARSBAR

SSBAR – SITUATIONBAR – SITUATION ““I am” (name and unit)I am” (name and unit)

““I am calling about” (patient’s name and I am calling about” (patient’s name and room number)room number)

““The problem that I am calling about is” The problem that I am calling about is” (state the problem)(state the problem)

SBARSBAR

SITUATION - exampleSITUATION - example

“This is Joe, a nurse on Seton 3, calling about your patient Mrs. Gaige in Room 3606 bed 2. The problem that I am calling you about is her new complaint of dyspnea and increasing respiratory rate.”

SBARSBAR

SSBBAR – BACKGROUNDAR – BACKGROUND State admission diagnosis and date of State admission diagnosis and date of

admissionadmission

Give Give briefbrief synopsis of hospital course and synopsis of hospital course and treatment to datetreatment to date

Give vital signs including SpO2 and physical Give vital signs including SpO2 and physical assessment pertinent to the problemassessment pertinent to the problem

SBARSBAR

BACKGROUND _ EXAMPLEBACKGROUND _ EXAMPLE Mrs. Gaige was admitted 3 days ago with Mrs. Gaige was admitted 3 days ago with

pneumonia.She’s been on Levaquin and pneumonia.She’s been on Levaquin and improving each day, no more fever and improving each day, no more fever and less cough and sputum. less cough and sputum.

Now her vital signs are RR=32 P=86, BP= Now her vital signs are RR=32 P=86, BP= 90/60, T=100.1 and SpO2= 88% on 2L.90/60, T=100.1 and SpO2= 88% on 2L.

Her breathing looks labored and she has Her breathing looks labored and she has new crackles in the right lower lobe.”new crackles in the right lower lobe.”

SBARSBAR

SBSBAAR – ASSESSMENTR – ASSESSMENT Give your impression of the present situation. A Give your impression of the present situation. A

diagnosis is not necessarydiagnosis is not necessary

If the situation is unclear, at least try to indicate If the situation is unclear, at least try to indicate what body system is involvedwhat body system is involved

State how severe the problem seems to beState how severe the problem seems to be

If appropriate, state the problem could be life If appropriate, state the problem could be life threateningthreatening

SBARSBAR

ASSESSMENT EXAMPLEASSESSMENT EXAMPLE

“ “I think Mrs. Gaige could be I think Mrs. Gaige could be developing worsening pneumonia developing worsening pneumonia in the right lower lobe.”in the right lower lobe.”

SBARSBAR

SBASBARR – RECOMMENDATION – RECOMMENDATION

Give the physician your recommendations Give the physician your recommendations for the interventions that you think should for the interventions that you think should be done, based on your assessmentbe done, based on your assessment

SBARSBAR

RECOMMENDATION – EXAMPLESRECOMMENDATION – EXAMPLES ““I have called the MET.”I have called the MET.”

““I think that you should come see the patient I think that you should come see the patient now.”now.”

““I think that you need to discuss code status with I think that you need to discuss code status with the family.”the family.”

““I think the patient needs a portable chest xray I think the patient needs a portable chest xray and blood cultures.and blood cultures.

SBARSBAR

BEFORE YOU CALL THE PHYSICIAN:BEFORE YOU CALL THE PHYSICIAN:

Have the patient’s chart, MAR and I & O sheetHave the patient’s chart, MAR and I & O sheet

Have today’s labsHave today’s labs

Review the most recent progress noteReview the most recent progress note

Review the nursing notes for past shiftReview the nursing notes for past shift

Know the patient’s code statusKnow the patient’s code status

SBARSBAR

What can you expect from MET?What can you expect from MET? Experienced ACLS team members and the Experienced ACLS team members and the

primary care nurse working collaboratively to primary care nurse working collaboratively to assist with the assessment of your patientassist with the assessment of your patient

A comprehensive and complete assessment of A comprehensive and complete assessment of your patientyour patient

Early intervention to slow or prevent clinical Early intervention to slow or prevent clinical deteriorationdeterioration

Critical Care at the bedsideCritical Care at the bedside Preventing Failure to RescuePreventing Failure to Rescue Decrease hospital morbidity and mortalityDecrease hospital morbidity and mortality

Testing METTesting MET

Team developed a policy for MET, which enabled Team developed a policy for MET, which enabled MET to perform stat EKG and ABG, without MET to perform stat EKG and ABG, without obtaining physician order first.obtaining physician order first.

Team developed an SBAR tool to guide primary Team developed an SBAR tool to guide primary nurse through call to primary physician.nurse through call to primary physician.

We began testing MET on the 11PM to 7AM shift We began testing MET on the 11PM to 7AM shift in October 2004.in October 2004.

MET members from ICU and Telemetry went unit MET members from ICU and Telemetry went unit to unit and presented a powerpoint education to unit and presented a powerpoint education face to face with staff.face to face with staff.

SBAR Communication Technique incorporated SBAR Communication Technique incorporated into education.into education.

Developed an evaluation tool to monitor the MET Developed an evaluation tool to monitor the MET calls.calls.

Testing METTesting MET Presented Medical Emergency Team to our Presented Medical Emergency Team to our

Medical Executive Committee (MEC).Medical Executive Committee (MEC). MEC voiced concern that there might be a delay MEC voiced concern that there might be a delay

in notifying the physician.in notifying the physician. We advised that the physician should be called We advised that the physician should be called

sooner than later if units called with established sooner than later if units called with established MET criteria.MET criteria.

ICU began to get calls on the day shift in early ICU began to get calls on the day shift in early November.November.

Team began to develop a plan to educate day Team began to develop a plan to educate day shift and evening shift on MET.shift and evening shift on MET.

Presented to Nursing Unit Educators, who then Presented to Nursing Unit Educators, who then educated their units on MET.educated their units on MET.

Testing METTesting MET

MET and SBAR presented at orientation.MET and SBAR presented at orientation.

SBAR tool made into pads that are located at SBAR tool made into pads that are located at nursing station near phone. Reordered through nursing station near phone. Reordered through our copy center.our copy center.

MET available all 3 shifts as of 12/23/04.MET available all 3 shifts as of 12/23/04.

ResultsResults

MET Average Response Time Goal: 10 minutes

0

5

10

15

20

ave m

inu

tes

ave resp time 3.2 3.6 2.8 3.2 3.3 3.7

# MET calls 11 9 4 14 12 16

1/05 2/05 3/05 4/05 5/05 6/05

ResultsResults

MET Average Time Spent on MET Call

MET Implemented 12/23/04

0

10

20

30

Ave

min

utes

ave time spent 18.5 22 19.8 14.7 26 20.9

# MET calls 11 9 4 14 12 16

1/05 2/05 3/05 4/05 5/05 6/05

ResultsResults

# of MET callsMET Implemented 12/23/04

0

5

10

15

20

1/05 2/05 3/05 4/05 5/05 6/05

#