Identifying and treating in-hospital patients with failing physiology
In-hospital ward patients suffer too often from serious adverse events, cardiac arrest and death. The risks increase as patients become older, more ill and stay in hospitals for shorter periods of time. Despite huge efforts to improve survival after in-hospital cardiac arrest, mortality is virtually unchanged since 40 years; 85 per cent.
Cardiac arrests in hospitals are preceded by deterioration in vital functions: breathing, circulation and conscious level, all easily detectable parameters. Patients with failing vital functions have a 10-fold increase in the risk of dying. This pattern is similar in developing countries.
By early detection and treatment of failing vital signs we aim to improve the prognosis for in-hospital ward patients.
The Medical Emergency Team is directed towards the hospital wards where any nurse directly can summon a team trained in intensive care, using predefined criteria. Automated risk-score calculations to aid decision-making in the wards are tried out. In collaboration with Muhimbili Hospital in Tanzania, we aim to improve prognosis for hospitalized patients by implementing goal-directed treatments based on failing vital signs.
By implementing the Medical Emergency Team at the Karolinska University Hospital, the cardiac arrest rate has decreased by 26 per cent and overall hospital mortality by 10 per cent.
|David Konrad||MD, PhD, Director of the Central Intensive Care Unit, Karolinska University Hospital Solna|
|Claes-Roland Martling||MD, PhD, Associate Professor|
|Max Bell||MD, PhD|
|Anders Ekbom||MD, PhD, Professor|
|Gabriella Jäderling||MD, PhD|
In need of intensive care - Medical Emergency Team admissions vs conventional admissions, characteristics and outcome
The purpose of the Medical Emergency Team (MET) is to find and treat deteriorating ward patients. Suboptimal care and delays on general wards before admission to intensive care has an effect on mortality (1) and patients admitted from general wards have a worse outcome than from the operating room (OR) or emergency department (ED) (2). MET patients have a high rate of intensive care unit (ICU) admissions but whether their outcome differs from other patients admitted from the wards has not been studied before. We evaluate characteristics and outcome of ICU patients based on mode of admittance, via the MET vs the conventional way.
Limitations of medical therapy in patents attended by the Rapid Response Team
The rapid response team is often called to patients with limitations of medical treatment or the call in itself might lead to such limitations. There is little information on the clinical charecterstics and outcome of these patients. We therefore currently study our whole cohort of rapid response team calls over a period of six years and compared the patients that had limitations to those that did not.
Vital signs directed therapy in emergency and intensive care in Tanzania
We aim to conduct a before-and-after interventional study to assess the effects of introducing an emergency assessment and treatment protocol in Emergency and Intensive Care in a hospital in Tanzania. The Vital Signs Directed Therapy protocol identifies patients with severely abnormal vital signs and task-shifts standardized emergency treatments from the doctors to the nurses facilitating quick and safe emergency management.
Main hypothesis: Vital Signs Directed Therapy can reduce mortality for critically ill patients in a low-income country.
- Vital Signs Directed Therapy (VSDT) can reduce physiological abnormalities in acutely ill patients in a low-income country.
- VSDT can be successfully introduced in a low-income country using an implementation package that includes training, information, treatment protocols, facilitation by local nurses and doctors, follow-up supervision, job aids, data collection and audit.
- VSDT, once established, will not increase costs and will thus make better use of available resources.
Intensive care unit admittance by a Medical Emergency Team vs conventional admittance, characteristics and outcome.
Jäderling G, Bell M, Martling CR, Granath F, Ekbom A, Konrad D.
Crit Care. 2012; 16(Suppl 1): P507.
Emergency and critical care services in Tanzania: a survey of ten hospitals.
BMC Health Serv Res 2013 Apr;13():140
The deteriorating ward patient: a Swedish-Australian comparison.
Intensive Care Med 2011 Jun;37(6):1000-5
Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team.
Intensive Care Med 2010 Jan;36(1):100-6
Prevalence and sensitivity of MET-criteria in a Scandinavian University Hospital.
Resuscitation 2006 Jul;70(1):66-73