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Dusk to Dawn Rapid Response: UK 911

Dusk to Dawn Rapid Response: UK 911. Patricia Burkhart, Cletus Carvalho , Rachel Copeland, Dan Goulson, Kathy Isaacs, Paula Sandford. Background.

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Dusk to Dawn Rapid Response: UK 911

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  1. Dusk to DawnRapid Response: UK 911 Patricia Burkhart, Cletus Carvalho, Rachel Copeland, Dan Goulson, Kathy Isaacs, Paula Sandford

  2. Background • UK HealthCare ranks in 4th quintile on quality and safety indicators for UHC hospitals, 2009 UHC Quality and Accountability Ranking; and 64/104 among UHC hospitals on inpatient mortality. • Retrospective review of seminal UK patient events (e.g., mortality) – root cause analysis of untoward patient outcomes identified night coverage as a system weakness

  3. Issues • Delayed activation of a rapid response to patient deterioration • Response personnel may not have appropriate skill set to intervene (Root cause analysis report)

  4. The right skills to help the patient at the right time

  5. Literature Review

  6. Internal Survey • Interviewed UK administrators, physicians, chief residents and nurses for their perspective on the problem related to after-hours coverage • Attended UK HealthCare Night Coverage Taskforce

  7. External Survey • Please describe your model for night coverage.  Is it the same throughout the hospital or does it vary by service? • Do you have a rapid response team?  How do they relate to your night coverage model? • In the event of a suspected patient deterioration, who does the bedside staff call first and how do they know who to call? Is there a designated communication mechanism that is activated? • If you have a rapid response team, what types of providers are members?  Do they have skills for doing invasive procedures such as chest tubes or endotracheal intubation? • Do you have any information on patient outcomes based on your particular model? • Have you done any financial analysis of your model?  Specifically, does your model enhance revenue generation? • If you use a hospitalist or nocturnist, what is the average salary?  What incentives are in place for night coverage?

  8. Intervention • Based on survey data, identify a potential mechanism to resolve after-hours coverage appropriate for UK Healthcare • Composition of rapid response team • Intensivist training program for appropriate skill set for response team • UK HealthCare wide communication system for rapid response (RRT contact number on ID badge) • Associated budget related to rapid response system/communication

  9. Model Scenario Table

  10. Conclusions • Mechanism for buy-in from stakeholders • Development of training program • Development of dissemination of UK HealthCare wide communication system • Development of time frame for implementation of new rapid response teams and communication system • Development of time frame for measurement of outcomes

  11. Recommendations • Three Prong Model • Hospitalist- (nocturnist) for night coverage 11pm – 7am • Rapid Response Team - 24/7 • Increase skill set at bedside - (BSN hires)…….

  12. References • Chen, J., Bellomo, R., Flabouris, A., Hillman, K., & Finfer, S. (2009). The relationship between early emergency team calls and serious adverse events. Critical Care Medicine, 37, 148-153. • Fletcher, K. E., Saint, S., & Mangrulkar, R. S. (2005). Balancing continuity of care with residents’ limited work hours: defining the implications. Academic Medicine, 80(1), 39-43. • Hillman, K., Parr, M., Flabouris, A., Bishop, G., & Stewart, A. (2001). Redefining in-hospital resuscitation: the concept of the medical emergency team. Resuscitation, 48, 105-110. • Hunt, E. A., Walker, A. R., Shaffner, D. H., Miller, M. R., & Pronovost, P. J. (2008). Simulation of in-hospital pediatric medical emergencies and cardiopulmonary arrest: highlighting the importance of the first 5 minutes. Pediatrics, 121, e34-e43. • Moldenhauer, K., Sabel, A., Chu, E. S., & Mehler, P. S. (2009). Clinical triggers: An alternative to a rapid response team. The Joint Commission Journal on Quality and Patient Safety, 35, 164-174. • Sharek, P. J., Parast, L. M., Leong, K., Coombs, J., Earnest, K., & Sullivan, J. et al. (2007). Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. JAMA, 298, 2267-2274. • Thomas, K., Force, M. V., Rasmussen, D., Dodd, D., & Whildin, S. (2007). Rapid response team: Challenges, solutions, benefits. Critical Care Nurse, 27(1), 20-27.

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