• Qual Manag Health Care · Jan 2018

    A Quality Improvement Initiative to Reduce "Out-of-ICU" Cardiopulmonary Arrests in a Tertiary Care Hospital in India: A 2-Year Learning Experience.

    • Vidya P Menon, Preetha Prasanna, Fabia Edathadathil, Sabarish Balachandran, Merlin Moni, Dipu Sathyapalan, Rajesh D Pai, and Sanjeev Singh.
    • Departments of General Medicine (Drs Menon, Moni, and Sathyapalan), Allied Health Sciences (Ms Edathadathil), and Emergency Medicine (Dr Balachandran), Amrita Institute of Medical Sciences, Ponekkara, Kochi, India (Ms Prasanna and Drs Pai and Singh).
    • Qual Manag Health Care. 2018 Jan 1; 27 (1): 39-49.

    Quality Problem Or IssueTo assess impact of medical emergency team (MET) in reducing "out-of-ICU" cardiopulmonary arrests and identify barriers to its optimal utilization.Initial AssessmentFrequently observed critical clinical signs and laboratory values of "out-of-ICU" crashes were used to develop Amrita Early Warning Criteria.Choice Of SolutionA physician-led MET was established to respond to code MET, activated by a primary nurse.ImplementationRates of "out-of-ICU" cardiopulmonary arrests per 1000 admissions were compared in pre-MET (2013-2014) and post-MET periods (2014-2016) along with disposition following MET and mortality. Descriptive statistics and logistic regression were used for comparative analysis.EvaluationFor continued quality improvement, a Likert agreement scale questionnaire collated the nurse's feedback on MET. 386 Code MET were recorded with an activation rate of 18.8 per 1000 inpatients for 2014-2016. Common MET triggers were desaturation (53%), seizure (10%), and syncope (9%). Seventy-one percent of activations were attended within 5 minutes, with 45% reported during nurse's night shift hours. Medical emergency team interventions resulted in 59% being shifted to ICU. In the "post-MET" period, "Cold Blue" dose reduced from 6.9 in 2013-2014 to 2.6 (P = .0002) in 2014-2015 and 3.2 (P = .01) in 2015-2016. Ninety-three percent of the Code Blues with prior MET calls were "delayed MET" and 28% of the Code Blues without prior MET activation were "missed MET." Nurse's feedback revealed that 46% lacked knowledge of correct MET activation process while 31% expressed a fear of reprisal for inappropriate activation.Lessons LearnedAlthough MET intervention was successful in significantly reducing "out-of-ICU" Code Blues, focused training of nurses is required for continued quality improvement.

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