Patient Instability, Emergencies, and Outcomes in Radiology
Patient Instability, Emergencies, and Outcomes in Radiology
Background Inpatients may be at risk of cardiopulmonary instability during radiologic testing. Calling the medical emergency team is one rescue intervention that brings a team of critical care providers to the unstable patient. Little is known, however, about patients' instability and activations of the medical emergency team in the radiology department (RD-MET).
Objectives To describe the cause of activation of the RD-MET for hospitalized patients, temporal attributes of RD-MET involvement, characteristics of RD-MET patients, and characteristics associated with good and poor outcomes after RD-MET activation.
Methods Retrospective pilot study of RD-MET calls for 64 inpatients in a tertiary care hospital during 2009.
Results Reasons for RD-MET activation were 39% neurological, 38% cardiac, and 22% respiratory, and nearly half (42%) occurred during a computed tomography scan. Most RD-MET calls were made between 10 AM and noon. RD-MET patients had a mean age of 61 (SD, 19) years; 52% were female, and 89% were white. Admitting diagnoses were most commonly neurological (20%), cardiovascular (16%), and abdominal (16%). The most common comorbid conditions were chronic obstructive pulmonary disease (23%) and diabetes (20%). Half of RD-MET inpatients were from a general care unit, and 56% required preexisting oxygen support. After RD-MET involvement, 61% of patients required a higher level of care; 3% died during the MET intervention, and 19% died later in hospitalization. Patients with preexisting comorbid conditions were more likely to have poor outcomes after the RD-MET intervention (P= .001).
Conclusions RD-MET patients with comorbid conditions, from a general care unit, and at risk for neurological deterioration arrive in the radiology department with potentially underestimated support needs. Greater support in specific time frames and locations may be warranted to improve outcomes. (American Journal of Critical Care. 2011;20:461–469)
Hospitalized patients who require diagnostic testing and procedures in the radiology department range from "stable" patients admitted for elective surgery to highly unstable critically ill patients who require a high level of human and technological monitoring and physiological support, including mechanical ventilation and hemodynamic support. Patients may be at risk for cardiopulmonary instability while undergoing diagnostic testing, and in some, that instability may progress to cardiorespiratory collapse. When instability occurs, one rescue intervention involves activation of a medical emergency team (MET) to bring a team of critical care providers to the imaging site. Although published reports describing MET activations and outcomes on clinical units within the hospital are fairly extensive, little is known about MET activations in diagnostic testing areas such as the radiology department. More information about the precursors of such events could lead to earlier detection of cardiopulmonary instability and improved outcomes in patients who require activation of the MET in the radiology department (RD-MET), inform interventions to prevent the need for RD-MET activation, and alter systems of care in the radiology department.
Rapid response to patients' instability has driven the establishment of METs, whose goal is to bring a cadre of critical care providers to the bedsides of patients in unstable condition outside of the intensive care unit (ICU). Once cardiopulmonary instability is recognized, the MET provides a rapidly available secondary system of ICU level support to all units throughout the hospital. MET systems usually provide hospital staff with a preset list of criteria to serve as "triggers" to initiate a MET call, and staff are both educated and encouraged to use this resource. The success of the MET is dependent on early recognition of deterioration in a patient's condition, rapid response by the bedside providers, and aggressive intervention to stabilize and rescue patients to prevent further deterioration in their condition.
The onset of cardiopulmonary instability is rarely acute, but shows a cyclic pattern of change.
Early detection of deterioration in patients' condition is key to successful intervention and may prevent complications. The onset of cardiopulmonary instability is rarely acute, but demonstrates a cyclic pattern of change with patients' heart rate, blood pressure, respiratory rate, and oxygen saturation moving above and below accepted parameters, sometimes for hours before deterioration in their condition is acknowledged.
Clinical antecedents to patients' cardiopulmonary instability have been detected 6 to 8 hours before recognized cardiorespiratory collapse. Owing to the cyclic pattern of these dynamic variables, cardiopulmonary instability may be missed by the intermittent clinical evaluation that may occur in the radiology department. Additionally, research has shown that patients being cared for in areas where the direct care providers are not specifically trained for their care requirements and diagnosis may be at greater risk for unrecognized cardiopulmonary instability and the need for MET activation. This situation often may occur in the radiology department, when patients at various levels of acuity receive care from staff members who are not familiar with their prior care needs, stability level, or particular diagnosis.
The purpose of this pilot study was to describe the reasons for RD-MET activation for hospitalized inpatients, the temporal attributes of RD-MET involvement, the characteristics of inpatients who experience RD-MET interventions, and the characteristics associated with outcomes after RD-MET activation.
Abstract and Introduction
Abstract
Background Inpatients may be at risk of cardiopulmonary instability during radiologic testing. Calling the medical emergency team is one rescue intervention that brings a team of critical care providers to the unstable patient. Little is known, however, about patients' instability and activations of the medical emergency team in the radiology department (RD-MET).
Objectives To describe the cause of activation of the RD-MET for hospitalized patients, temporal attributes of RD-MET involvement, characteristics of RD-MET patients, and characteristics associated with good and poor outcomes after RD-MET activation.
Methods Retrospective pilot study of RD-MET calls for 64 inpatients in a tertiary care hospital during 2009.
Results Reasons for RD-MET activation were 39% neurological, 38% cardiac, and 22% respiratory, and nearly half (42%) occurred during a computed tomography scan. Most RD-MET calls were made between 10 AM and noon. RD-MET patients had a mean age of 61 (SD, 19) years; 52% were female, and 89% were white. Admitting diagnoses were most commonly neurological (20%), cardiovascular (16%), and abdominal (16%). The most common comorbid conditions were chronic obstructive pulmonary disease (23%) and diabetes (20%). Half of RD-MET inpatients were from a general care unit, and 56% required preexisting oxygen support. After RD-MET involvement, 61% of patients required a higher level of care; 3% died during the MET intervention, and 19% died later in hospitalization. Patients with preexisting comorbid conditions were more likely to have poor outcomes after the RD-MET intervention (P= .001).
Conclusions RD-MET patients with comorbid conditions, from a general care unit, and at risk for neurological deterioration arrive in the radiology department with potentially underestimated support needs. Greater support in specific time frames and locations may be warranted to improve outcomes. (American Journal of Critical Care. 2011;20:461–469)
Introduction
Hospitalized patients who require diagnostic testing and procedures in the radiology department range from "stable" patients admitted for elective surgery to highly unstable critically ill patients who require a high level of human and technological monitoring and physiological support, including mechanical ventilation and hemodynamic support. Patients may be at risk for cardiopulmonary instability while undergoing diagnostic testing, and in some, that instability may progress to cardiorespiratory collapse. When instability occurs, one rescue intervention involves activation of a medical emergency team (MET) to bring a team of critical care providers to the imaging site. Although published reports describing MET activations and outcomes on clinical units within the hospital are fairly extensive, little is known about MET activations in diagnostic testing areas such as the radiology department. More information about the precursors of such events could lead to earlier detection of cardiopulmonary instability and improved outcomes in patients who require activation of the MET in the radiology department (RD-MET), inform interventions to prevent the need for RD-MET activation, and alter systems of care in the radiology department.
Rapid response to patients' instability has driven the establishment of METs, whose goal is to bring a cadre of critical care providers to the bedsides of patients in unstable condition outside of the intensive care unit (ICU). Once cardiopulmonary instability is recognized, the MET provides a rapidly available secondary system of ICU level support to all units throughout the hospital. MET systems usually provide hospital staff with a preset list of criteria to serve as "triggers" to initiate a MET call, and staff are both educated and encouraged to use this resource. The success of the MET is dependent on early recognition of deterioration in a patient's condition, rapid response by the bedside providers, and aggressive intervention to stabilize and rescue patients to prevent further deterioration in their condition.
The onset of cardiopulmonary instability is rarely acute, but shows a cyclic pattern of change.
Early detection of deterioration in patients' condition is key to successful intervention and may prevent complications. The onset of cardiopulmonary instability is rarely acute, but demonstrates a cyclic pattern of change with patients' heart rate, blood pressure, respiratory rate, and oxygen saturation moving above and below accepted parameters, sometimes for hours before deterioration in their condition is acknowledged.
Clinical antecedents to patients' cardiopulmonary instability have been detected 6 to 8 hours before recognized cardiorespiratory collapse. Owing to the cyclic pattern of these dynamic variables, cardiopulmonary instability may be missed by the intermittent clinical evaluation that may occur in the radiology department. Additionally, research has shown that patients being cared for in areas where the direct care providers are not specifically trained for their care requirements and diagnosis may be at greater risk for unrecognized cardiopulmonary instability and the need for MET activation. This situation often may occur in the radiology department, when patients at various levels of acuity receive care from staff members who are not familiar with their prior care needs, stability level, or particular diagnosis.
The purpose of this pilot study was to describe the reasons for RD-MET activation for hospitalized inpatients, the temporal attributes of RD-MET involvement, the characteristics of inpatients who experience RD-MET interventions, and the characteristics associated with outcomes after RD-MET activation.
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