In our institution, the critical care admitting resident (CCAR) assesses unstable patients on the general wards. The assessment time and implementation of the appropriate intervention is crucial in patients’ outcome. We reviewed whether the implementation of a standardized evaluation facilitated this process and effected survival.
The CCAR was required to complete a single page “assessment sheet” which included pertinent medical background, current clinical status, as well as a plan of therapy. The general goal was to have the assessment and discussion with the medical intensivist done within 20 minutes of receiving the consult. We then did a retrospective chart review with attention paid to the time of implementation of therapies, as well as their effect on patient mortality. Incomplete evaluations and those with do not resuscitate orders (DNR) were excluded from outcome data.
70 of 138 evaluations (51%) were done and discussed with the medical intensivist within 20 minutes, resulting in an overall survival rate of 88%. An additional 59 patients were evaluated in the 21–40 minute interval, resulting in a 92% survival rate. Overall, 129 patients (93%) were evaluated within 40 minutes, leading to an overall 90% survival rate. It was also observed that therapy implemented early by the primary team, (i.e. before the CCAR was called), led to 93% survival rate (64 of 69 patients).
Implementation of therapy in a succinct manner to critically ill patients results in better outcome. By initiating an “assessment sheet,” we have provided a more streamlined approach to evaluate critically ill patients for physicians in training. Secondly, we observed a significant improvement in survival when an intervention was made early; even prior to contacting the critical care team.
Standardized evaluation of critically ill patients for residents in training will lead to faster implementation of therapy, which has been shown to improve outcome. Using this data, we can emphasize early intervention into the training curriculum.
Ali Massoumi, No Financial Disclosure Information; No Product/Research Disclosure Information