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Intervention Intensity in Inpatients With New vs Ongoing Decompensation FREE TO VIEW

Ronaldo Sevilla Berrios; John O'Horo; Alice Gallo de Moraes; Gina Iacovella; Jennifer Elmer; Jeffrey Jensen; Sean Caples
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Mayo Clinic, Rochester, MN

Chest. 2014;146(4_MeetingAbstracts):561A. doi:10.1378/chest.1992812
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SESSION TITLE: Patient Safety Initiative Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Hospitalized patients often suffer clinical deterioration that may lead to poor outcomes. This decline is often subtle and may progresses over hours prior to the on-set of a medical emergency. As a result of the Institute of Healthcare Improvement (IHI) 2005 “Protecting 5 million lives” initiative, rapid response systems were recommended as a tool to bring critical care expertise to the bedside of these non ICU deteriorating patients. In those deteriorating patients it is unclear if the level of resource utilization is different between those whose decompensation was related to their original admission medical problem or from an unrelated issue.

METHODS: As part of a quality improvement project,, we evaluated whether there was any similarity between the original reason for hospital admission and the reason for RRT activation. Additionally, we compared resource utilization between these groups. An anonymous, electronic survey was sent to all RRT team leaders following the activation and a subsequent chart review was done looking at the hospital admission diagnosis, reason for RRT activation, and resource utilization. In cases of uncertainty regarding diagnosis at admission and reason for RRT activation, there was extensive discussion amongst the authors with majority opinion prevailing.

RESULTS: There were a total of 92 RRT activations during the observation period. The most common admitting diagnosis by system included hematologic (33%), gastrointestinal (21%), and respiratory (13%). However, the most common organ systems responsible for RRT activations were cardiovascular (49 %), respiratory (33%) and neurological (12%). The reason for hospital admission and RRT activation was the same in 52% of cases. There was similar resource utilization between both groups. Time spent at bedside (28.3 vs 28.5 min p = 0.94), rate of transfer to ICU (59% vs 62%, p =0.85), vasopressor requirement (17% vs 10% p =0.28), central line placement (15% vs 10% p =0.41), non-invasive mechanic ventilation use (7% vs 9% p = 0.61), and invasive mechanic ventilation (19 vs 12% p = 0.32) were no different.

CONCLUSIONS: These preliminary observations suggest that admission diagnosis is not a good predictor of future RRT activations and resource utilization. Patient decompensation is difficult to predict and are novel problems unrelated to their initial diagnosis.

CLINICAL IMPLICATIONS: It is important to mantaint a high standard of quality care irrespectevible of the reason of clinical deterioration in hospitalized patients.

DISCLOSURE: The following authors have nothing to disclose: Ronaldo Sevilla Berrios, John OHoro, Alice Gallo de Moraes, Gina Iacovella, Jennifer Elmer, Jeffrey Jensen, Sean Caples

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