PURPOSE: The purpose of this study is to evaluate whether an intensive hospital wide mandatory web-based training tool (WBTT) would increase the frequency of Medical Emergency Team (MET) utilization and decrease “Code Blue” events (CBE).
METHODS: A WBTT describing the purpose and indications for MET was developed. All hospital employees with regular patient contact were required to complete the WBTT. The frequency of MET and Code Blue events [including cardiopulmonary arrests (CPA), acute respiratory compromise events (ARC) requiring rescue breathing and other CBE not requiring either cardio or pulmonary resuscitation (NonCPR)] and hospital mortality rates were collected before and after WBTT. CPA and ARC events were defined per AHA guidelines.
RESULTS: Data was collected from April 2007 through September 2010. Both pre and post WBTT periods were 21 months in length (April 2007-December 2008 and January 2009-September 2010, respectively). WBTT was completed by the majority of staff during the months of December 2009 and January 2010. Monthly frequency of MET events/1000 discharge in the post-WBTT period was significantly higher compared to that of the pre-WBTT period, 31.3 (CI 27.1-34.1) vs. 17.3 (CI 15.9-18.7), p<0.0001. Monthly frequency of all Code Blue events/1000 discharge did not differ before and after WBTT 6.4±2.0 vs. 7.5±1.8 (p=0.0753), nor did the mortality index differ, 1.0±0.1 vs. 1.0±0.2 (p=0.7113), respectively. However, the monthly frequency of NonCPR events significantly declined from 4.2±1.6 before to 2.9±1.0 after WBTT (both per 1000 discharge), p=0.147. Regression analysis revealed the frequency of ARC events significantly declined during the period after WBTT implementation (p=0.0288).
CONCLUSIONS: A mandatory WBTT to educate staff about the purpose and indications of MET may lead to increased utilization of MET services and decreased Code Blue events requiring rescue breathing but may not reduce all Code Blue events.
CLINICAL IMPLICATIONS: Use of a WBTT may reduce inappropriate Code Blue activations while maintaining high clinical acuity and critical care resource allotment appropriate for the patient who does not require CPR or rescue breathing.
DISCLOSURE: The following authors have nothing to disclose: Anne Bagley, Joseph English, Therese Golden, Kristin Mitchell, W. Bohnert, Timothy Liesching
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