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Examination of Stat Response Team Data Investigating Mortality, Increased Level of Care, and Change in DNR Status at the University of Louisville Hospital FREE TO VIEW

Michael Scott*, DO; Patton Thompson, MD; Timothy Wiemken, PhD; Sajjad Jameel, MD; Linda Hummel, BS; Linda Goss, BS; Rodrigo Cavallazzi, MD; Mohamed Saad, MD
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University of Louisville, Louisville, KY

Chest. 2012;142(4_MeetingAbstracts):380A. doi:10.1378/chest.1390417
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SESSION TYPE: ICU Safety and Quality Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Recent studies have failed to show a mortality benefit after the institution of Stat Response Teams (SRTs). To our knowledge, no systematic review has examined if the reason for stat response was associated with specific outcomes (increased level of care, mortality, and change in Do Not Resuscitate (DNR) status). We propose that respiratory distress accounts for the majority of changes in these outcomes.

METHODS: A retrospective review of 177 SRT summaries from January 2010 to August 2011 was conducted. Reasons for activating SRT were grouped into eight categories: respiratory distress, systolic blood pressure less than 90, chest pain, dysrhythmia, acute bleeding, acute change in neurologic status, hypoglycemia, and other. Statistical analysis used Chi-Square or Fisher’s Exact Test to identify which of the eight categories were associated with outcomes of requiring increased level of care, mortality, and change in DNR status. P-values of ≤0.05 were significant.

RESULTS: The data showed a statistically significant increased level of care (P = 0.0047), mortality (P = 0.0185), and change in DNR status (P = 0.0089) in the respiratory distress category. Also, increased level of care was seen in the dysrhythmia category (P = 0.0065). 46% of patients requiring increased level of care were in the respiratory distress category and 18% were in the dysrhythmia category. Respiratory distress accounted for 60% of mortality after stat response, and 61% of those that changed DNR status. One interesting finding was that those with increased level of care were actually less likely to have acute change in neurologic status (P = 0.0002), hypoglycemia (0.0080), or other category (P = 0.0185).

CONCLUSIONS: Respiratory distress was associated with a need for increased level of care, higher mortality, and change in DNR status. Also, there was a significant increased level of care in the dysrhythmia category.

CLINICAL IMPLICATIONS: SRT calls for respiratory distress or dysrhythmia should raise clinical concern. These patients are at higher risk for deterioration, should receive more vigilant care, and deserve earlier consideration for transfer to higher level of care. These findings suggest that stat responses for respiratory distress or dysrhythmia should be examined individually to see if these categories of stat responses result in a mortality difference.

DISCLOSURE: The following authors have nothing to disclose: Michael Scott, Patton Thompson, Timothy Wiemken, Sajjad Jameel, Linda Hummel, Linda Goss, Rodrigo Cavallazzi, Mohamed Saad

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University of Louisville, Louisville, KY




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