Improving the utilization of medical crisis teams (Condition C) at an urban tertiary care hospital,☆☆

https://doi.org/10.1053/jcrc.2003.50002Get rights and content

Abstract

Purpose: Serious clinical deterioration precedes most cardiopulmonary arrests, and there is evidence that organized responses to this deterioration may prevent a substantial proportion of in-hospital deaths. We aimed to increase the utilization of our medical crisis response team (Condition C) to impact this source of mortality. Methods: We have examined the change in numbers of Condition Cs and the main alternative response strategy (sequential stat pages) after the implementation of 4 strategies to increase Condition C utilization: (1) immediate reviews of all sequential STAT pages, (2) feedback to caregivers responsible for delays in Condition C activation, (3) creation of objective criteria for invoking a crisis response, and (4) dissemination of objective criteria through posting in units, e-mail, and in-service oral presentations. Results: Over a 3-year period, interventions were followed by increased use of organized responses to medical crises (Condition Cs) and decreased numbers of disorganized responses (sequential STAT pages). The interventions that involved objective definition and dissemination of criteria for initiating the Condition C response were followed by 19.2 more Condition Cs monthly (95% confidence interval [CI], 12.1-26.3; P < .0001) and 5.7 fewer sequential STAT pages monthly (95% CI, 3.2-8.2). The interventions that involved giving feedback to medical personnel based on review of their care were not associated with changes in the measures. Conclusion: Utilization of an important patient safety measure may be increased by focused interventions at an urban tertiary care hospital. © 2003 Elsevier Inc. All rights reserved.

Section snippets

Setting

This experience is part of a larger, ongoing patient safety and quality improvement effort at the University of Pittsburgh Medical Center (UPMC) designed to: (1) improve responses to medical crises and (2) investigate medical crises to uncover and remediate processes of care that may have contributed.

UPMC Presbyterian University Hospital (UPMC-P) is a tertiary care, university hospital complex with 567 licensed beds, with 116 critical care beds in 11 intensive care units. There are no

Results

Over a 3-year period, interventions increased the use of organized responses to medical crises (Condition C) and decreased the number of disorganized responses (sequential stat pages).

Discussion

At an urban tertiary care hospital, it was possible to increase the use of a medical emergency team (Condition C at our institution) through institutional interventions. Before these interventions, in our hospital (as in most hospitals in the United States), stat paging was commonly used to immediately summon additional caregivers to the patient's bedside during medical crises (eg, more experienced nurses, a physician, a respiratory therapist, and so forth). In many cases, especially when

Conclusion

Our report focuses on the methodology used to foster behavior change. The rationales for the change are presented and focus on providing a more reliable and expert response to patient crisis. We show that a hospital can change recognition of and response to crisis. We suggest, but do not show, that the change desired may improve outcome.

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Address reprint requests to Michael A. DeVita, MD, C-111 UPMC Presbyterian Hospital, 200 Lothrop St, Pittsburgh, PA 15213; e-mail: [email protected].

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