PURPOSE:Mount Sinai Hospital (MSH), Toronto ON, provides critical care services to a 220-bed dedicated oncology hospital, Princess Margaret Hospital (PMH). A critical care response team (CCRT) was implemented in this unique environment. The utility of early identification of ill cancer patients in altering outcomes was evaluated.
METHODS:A retrospective chart review before and after establishment of a CCRT at PMH was performed. Data was abstracted from charts of patients admitted to the MSH ICU from PMH wards for two time periods, April to September 2006 (pre-CCRT) and April to September 2007 (post-CCRT). Data for PMH mortality and cardiac arrests was collected for the April to September period from 2004 through 2007.
RESULTS:The CCRT responded to 100 PMH calls in the 6 month time period (50 calls/1000 admissions), with 44% of patients requiring transfer to an ICU. Following the implementation of the CCRT, the ICU admissions from the target hospital increased from 11.8 to 28.5 per 1000 patient admissions. ICU mortality increased from 32% to 47%, consistent with a significant increase in the average APACHE2 illness severity score from 20.5 ± 7.33 (35% predicted mortality) to 24.1 ± 7.77 (45% predicted mortality), p=0.048. ICU length of stay was not significantly changed, 6.14 ± 6.07 days to 6.02 ± 6.17 days, p=0.93. After introducing the CCRT, mortality per 1000 admissions at PMH significantly decreased from 79.4 (95% CI 78.0–80.9) to 63.9 (CI 61.7–66.2). Cardiac arrests per 1000 admissions were non-significantly decreased from 8.65 (CI 7.01–10.3) to 6.99 (CI 4.85–9.14).
CONCLUSION:The introduction of a CCRT at a tertiary-care oncology hospital significantly increased admissions to the ICU. These patients had a greater severity of illness, with resultant higher ICU mortality. However, the rates of cardiac arrest and mortality in the target hospital were both decreased. The CCRT appears to have provided a significant benefit by early identification and transfer of critically ill oncology patients to the ICU, with resultant improved hospital mortality.
CLINICAL IMPLICATIONS:CCRTs may improve mortality in an inpatient oncology population.
DISCLOSURE:Matthew Heffer, No Financial Disclosure Information; No Product/Research Disclosure Information