A Quality Improvement Initiative to Reduce "Out-of-ICU" Cardiopulmonary Arrests in a Tertiary Care Hospital in India: A 2-Year Learning Experience.

摘要: Quality problem or issue To assess impact of medical emergency team (MET) in reducing "out-of-ICU" cardiopulmonary arrests and identify barriers to its optimal utilization. Initial assessment Frequently observed critical clinical signs laboratory values crashes were used develop Amrita Early Warning Criteria. Choice solution A physician-led MET was established respond code MET, activated by a primary nurse. Implementation Rates per 1000 admissions compared pre-MET (2013-2014) post-MET periods (2014-2016) along with disposition following mortality. Descriptive statistics logistic regression for comparative analysis. Evaluation For continued quality improvement, Likert agreement scale questionnaire collated the nurse's feedback on MET. 386 Code recorded an activation rate 18.8 inpatients 2014-2016. Common triggers desaturation (53%), seizure (10%), syncope (9%). Seventy-one percent activations attended within 5 minutes, 45% reported during night shift hours. Medical interventions resulted 59% being shifted ICU. In "post-MET" period, "Cold Blue" dose reduced from 6.9 2013-2014 2.6 (P = .0002) 2014-2015 3.2 .01) 2015-2016. Ninety-three Blues prior calls "delayed MET" 28% without "missed MET." Nurse's revealed that 46% lacked knowledge correct process while 31% expressed fear reprisal inappropriate activation. Lessons learned Although intervention successful significantly Blues, focused training nurses is required improvement.