Crit Care Resusc
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Most studies of the rapid response team (RRT) investigate the effect of introducing an RRT on outcomes of all hospitalised patients. Less information exists on RRT patient epidemiology, or changes in RRT call numbers with time. ⋯ Annual RRT calls are increasing in many Australian hospitals, and now affect more than 14 700 patients annually. Inhospital mortality of RRT patients is about 25%, and about 20% of patients who die in hospital are reviewed by the RRT. Further research is needed to understand the reason for the high inhospital mortality of RRT patients.
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Despite extensive work to improve early recognition of and response to abnormal vital signs, a failure or delay in response to clinical deterioration by activating a medical emergency team (MET) can affect patient safety. ⋯ Despite one in seven patients fulfilling MET criteria, MET activation occurred infrequently. The presence of MET criteria was associated with a doubling of the hospital LOS. Escalation of care in response to detection of MET criteria fulfillment was variable. Further research tracking patient management is needed to understand the decision-making process that occurs in the presence of clinical deterioration.
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Observational Study
Intensive care unit occupancy after introduction of the emergency department 4-hour discharge rule at a tertiary referral hospital in Western Australia.
The 4-hour rule has been introduced in Western Australia, requiring that emergency department (ED) patients be admitted to hospital or discharged from the ED within 4 hours of presentation. We hypothesised that this rule might have been associated with changes in medical emergency team (MET) calls and intensive care unit exit bed block. ⋯ The introduction of the 4-hour rule was associated with increased exit block from the ICU, but not with increased MET calls to attend to unstable or deteriorating ward patients. Introduction of the 4-hour rule was associated with a small reduction in hospital mortality.
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Multicenter Study Observational Study
Oxygen therapy in non-intubated adult intensive care patients: a point prevalence study.
Oxygen is commonly administered to intensive care unit patients. Although there is knowledge of how oxygen is administered to mechanically ventilated patients, there are few data about its use in non-intubated ICU patients. ⋯ Oxygen therapy is commonly administered to non-intubated adult patients in New Zealand and Australian ICUs. Most patients received oxygen by simple nasal cannulae, and oxygen therapy prescriptions were often absent or incomplete. We advise continuing education to ensure that oxygen is prescribed, administered and documented correctly.
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Multicenter Study
Sodium administration in critically ill patients in Australia and New Zealand: a multicentre point prevalence study.
Inadvertent sodium administration in excess of recommended daily requirements has been reported during routine care of critically ill patients. ⋯ This point prevalence study suggests that sodium administration in excess of recommended daily requirements may be common in Australia and New Zealand ICUs. The main sodium source was IV maintenance fluids, followed by fluid boluses and drug boluses.