Effects of admission (adm) source, time, and provider on inpatient (inpt) oncology (onc) outcomes at the Cleveland Clinic Foundation (CCF).

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 140-140
Author(s):  
Wee Christopher ◽  
Lindsey Martin Goodman ◽  
Lisa A. Rybicki ◽  
Alberto J. Montero ◽  
Bassam N. Estfan ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Tertiary Care ◽  
Medical Emergency Team ◽  
Cleveland Clinic ◽  
Healthcare Setting ◽  
Cleveland Clinic Foundation ◽  
Adverse Outcomes ◽  
Medical Emergency ◽  
Provider Type ◽  
Emergency Team

140 Background: The quality of care transfers is known to influence clinical outcomes. In an inpt onc setting at a major tertiary care referral center, patient (pt) adm originate from many different areas and times. A detailed evaluation of onc adm by source of transfer, admission time, and provider type, may identify opportunities to improve inpt clinical outcomes. Methods: We retrospectively reviewed all adm to the inpt solid tumor onc service from July - December 2014 from CCF regional hospital emergency departments (ED), outside hospital (OSH) ED, OSH inpt services, and CCF outpt clinics. Pts were excluded if the adm was planned or if admitted from the CCF Main Campus ED. Data collected included pt and encounter characteristics and provider type (house-staff or nocturnal hospitalist). Clinical outcomes, including activation of the adult medical emergency team (AMET), ICU transfers, length of stay (LOS), and in-hospital mortality were compared using chi-squared test; ECOG PS and LOS with the Kruskal-Wallis tests and Wilcoxon rank sum test. Results: A total of 413 unique pt admissions were reviewed. 213 were included after exclusion criteria were applied. The probability of AMET activation, mortality, and LOS differed by origin of transfer. Pts admitted from CCF regional EDs had the lowest median LOS and no deaths. OSH int transfers demonstrated significantly higher mortality vs other origins of transfer. Pts whose first orders were placed after 5pm had no significant differences in AMET activation, ICU transfers, LOS, or mortality vs daytime adm. There were no differences in adverse outcomes by the type of admitting provider. Conclusions: Onc inpts transferred from an outside healthcare setting were at highest risk for adverse outcomes (AMETs, increased LOS, and mortality) include those originating from OSH inpt services. Process and communication interventions focused on transfers from outside inpt facilities may improve safety and outcomes in this population. [Table: see text]

scholarly journals Analysis of Origins of Admission for Solid Tumor Oncology Inpatients: Disease Severity and Outcomes

2017 ◽  
Vol 13 (7) ◽  
pp. e666-e672
Author(s):  
Christopher E. Wee ◽  
Lindsey M. Goodman ◽  
Leticia Varella ◽  
Lisa A. Rybicki ◽  
Alberto J. Montero ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Disease Severity ◽  
Solid Tumor ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Provider Type ◽  
Main Campus ◽  
Emergency Team ◽  
Risk Of Mortality ◽  
Time Of Admission

Purpose: Hospital transfers may affect clinical outcomes. Evaluation of admission by source of transfer, time of admission, and provider type may identify opportunities to improve inpatient outcomes. Methods: We reviewed charts of patients admitted to the solid tumor oncology service between July and December 2014 from the Cleveland Clinic Foundation (CCF) Main Campus emergency department (ED), CCF Regional EDs, outside hospital (OSH) ED, OSH inpatient services, and CCF outpatient clinics. Data collected included time of admission, mortality and severity risk scores, and provider type. Risk factors were assessed for clinical outcomes, including activations of the Adult Medical Emergency Team, intensive care unit transfers, in-hospital mortality, and length of stay (LOS). Results: Five hundred admissions were included. OSH inpatient transfers had significantly higher disease severity compared with all other origins of admission. OSH inpatient transfers demonstrated significantly longer LOS compared with all other origins of admission, and higher mortality rates compared with the outpatient direct admits and CCF Main Campus ED admits. After adjusting for disease severity and risk of mortality, OSH ED patients remained at higher risk for Adult Medical Emergency Team activation, OSH inpatient transfers had the longest LOS, and CCF Main Campus ED patients had the lowest risk of mortality. Time of admission and provider type were not associated with any of the outcomes. Conclusion: Oncology inpatients transferred from an outside health care facility are at higher risk for adverse outcomes. The magnitude of difference is lessened, but still significant, after adjustment for disease severity and risk of mortality.

scholarly journals Timing and Location of Medical Emergency Team Activation Is Associated with Seriousness of Outcome: An Observational Study in a Tertiary Care Hospital

PLoS ONE ◽  
2016 ◽  
Vol 11 (12) ◽  
pp. e0168729 ◽  
Author(s):  
Takeo Kurita ◽  
Taka-aki Nakada ◽  
Rui Kawaguchi ◽  
Koichiro Shinozaki ◽  
Ryuzo Abe ◽  
...  
Keyword(s):  
Observational Study ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Care Hospital ◽  
Emergency Team

Abstract 264: Use of an Acronym to Reduce Medical Emergency Call Time and Improve Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Karen M Graves ◽  
Lee Anne Siegmund
Keyword(s):  
Cardiopulmonary Arrest ◽  
Medical Emergency Team ◽  
Survival Rates ◽  
Cleveland Clinic ◽  
Rapid Response ◽  
Medical Emergency ◽  
Quality Improvement Initiative ◽  
Emergency Team ◽  
Clinically Important Difference ◽  
The Right

Introduction: An average of 1500 medical emergencies are called to the operators each month for the main campus Cleveland Clinic. Acronyms can help the employee to remember necessary information to quickly and accurately activate the right medical emergency team in a short time. We developed the acronym LEAN (L-Location, E-Event Type; code or rapid response, A-Adult or Child, N-Call back number). We reduced the length of the call which led to the prompt activation of the medical emergency team. Hypothesis: We hypothesized that this quality improvement initiative, using the LEAN acronym would: 1. Reduce length of call time to the operator and 2. Lead to increased event survival of event for patients who have had a life-threatening medical emergency. Methods: The LEAN acronym was implemented in 2016 by sharing this acronym at staff meetings, and daily huddles. We developed an operator scorecard which tracked the average call time to the 111 (code) and 122 (rapid response) operator lines before and after LEAN implementation. We used our AHA Get With The Guidelines-Resuscitation® data to determine cardiopulmonary arrest (CPA) event survival. Results: Since August of 2016 we have reduced our 122 rapid response calls by 30 seconds and our 111 code calls by 12 seconds. CPA survival rates were 73% (437 of 599) in 2015 and 78.9% (548 of 703) in 2017, for an 8.1% increase ( Figure 1 ). While there is not a statistically significant ( p = 0.511) difference between time periods when we look at percentage of lives saved, the number of lives saved increased. This is a clinically important difference because more people survived. We plan to continue to disseminate LEAN and work to improve response time. Conclusion: Since we introduced LEAN there has been a reduction in the time to activation of our medical emergency teams and an 8% increase in our GWTG-R® Cardiopulmonary Arrest event survival. Lives were saved and LEAN may have played a role in this clinically important difference.

scholarly journals Diurnal Variation in Medical Emergency Team Calls at a Tertiary Care Children’s Hospital

2020 ◽  
Vol 5 (5) ◽  
pp. e341
Author(s):  
Susan R. Conway ◽  
Ken Tegtmeyer ◽  
Derek S. Wheeler ◽  
Allison Loechtenfeldt ◽  
Erika L. Stalets ◽  
...  
Keyword(s):  
Diurnal Variation ◽  
Tertiary Care ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Emergency Team ◽  
Children's Hospital ◽  
Children’S Hospital

Clinical Outcomes of patients triggering Medical Emergency Team calls for sinus tachycardia

2020 ◽  
Author(s):  
Arunbalaji Muthusamy ◽  
Ameera S Amiruddin ◽  
Elizabeth S L Low ◽  
Chamila D M Liyanage ◽  
Blake P Mumford ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Sinus Tachycardia ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Emergency Team

scholarly journals Characteristics of Medication Use During Pediatric Medical Emergency Team Events and the Role of a Pharmacist-Provided Medication Supply

2012 ◽  
Vol 17 (3) ◽  
pp. 236-245 ◽  
Author(s):  
Melania M. Bembea ◽  
Kristine A. Rapan Parbuoni ◽  
Karen P. Zimmer ◽  
Michael A. Veltri ◽  
Nicole A. Shilkofski ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Medical Emergency Team ◽  
Training Model ◽  
Medical Emergency ◽  
Rapid Sequence Intubation ◽  
Emergency Team ◽  
Emergency Medication ◽  
Rapid Sequence ◽  
Event Location ◽  
Observational Cohort

OBJECTIVES To determine the type and frequency of and indications for medications used during pediatric medical emergency team (PMET) events and to describe a PMET pharmacist training model, creation of a standardized “pharmacist PMET supply,” and the pharmacist's role in implementation and ongoing improvement of a PMET. METHODS This is a retrospective observational cohort study of 210 PMET events in 172 patients in a tertiary care, academic pediatric hospital, from September 15, 2005, to September 15, 2007. We focused on the types and sources of medications used during PMET events. RESULTS The medications most commonly used were lorazepam (11%), neuromuscular blockers (10.5%), atropine (9.5%), epinephrine bolus (9%), and albuterol or levalbuterol (9%). However, 49 distinct medications were used in 53.8% of all PMET events. Of all medications requested during a PMET event, only 40% originated from an institutionally standardized emergency medication box, while an additional 35% were readily available at the patient's bedside as part of the “pharmacist PMET supply.” CONCLUSIONS A wide variety of medications are required to care for children who suffer acute in-hospital deterioration. The pharmacist's medication supply and expertise ensured immediate availability of therapies for clinical entities ranging from seizures and anaphylaxis to rapid sequence intubation, regardless of the PMET event location.

scholarly journals Automated alert and activation of medical emergency team using early warning score

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Soo Jin Na ◽  
Ryoung-Eun Ko ◽  
Myeong Gyun Ko ◽  
Kyeongman Jeon
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Medical Emergency Team ◽  
Early Warning Score ◽  
Medical Emergency ◽  
Alert System ◽  
Primary Analysis ◽  
Emergency Team ◽  
Activation System ◽  
Implementation Period

Abstract Background Timely recognition of warning signs from deteriorating patients and proper treatment are important in improving patient safety. In comparison to the traditional medical emergency team (MET) activation triggered by phone calls, automated activation of MET may minimize activation delays. However, limited data are available on the effects of automated activation systems on the time from derangement to MET activation and on clinical outcomes. The objective of this study was to determine the impact of an automated alert and activation system for MET on clinical outcomes in unselected hospitalized patients. Methods This is an observational study using prospectively collected data from consecutive patients managed by the MET at a university-affiliated, tertiary hospital from March 2013 to December 2019. The automated alert system automatically calculates the Modified Early Warning Score (MEWS) and subsequently activates MET when the MEWS score is 7 or higher, which was implemented since August 2016. The outcome measures of interest including hospital mortality in patients with MEWS of 7 or higher were compared between pre-implementation and post-implementation groups of the automated alert and activation system in the primary analysis. The association between the implementation of the system and hospital mortality was evaluated with logistic regression analysis. Results Of the 7678 patients who were managed by MET during the study period, 639 patients during the pre-implementation period and 957 patients during the post-implementation period were included in the primary analysis. MET calls due to abnormal physiological variables were more common during the pre-implementation period, while MET calls due to medical staff’s worries or concern about the patient’s condition were more common during the post-implementation period. The median time from deterioration to MET activation was significantly shortened in the post-implementation period compared to the pre-implementation period (34 min vs. 60 min, P < 0.001). In addition, unplanned ICU admission rates (41.2% vs. 71.8%, P < 0.001) was reduced during the post-implementation period. Hospital mortality was decreased after implementation of the automated alert system (27.2% vs. 38.5%, P < 0.001). The implementation of the automated alert and activation system was associated with decreased risk of death in the multivariable analysis (adjusted OR 0.73, 95% CI 0.56–0.90). Conclusions After implementing an automated alert and activation system, the time from deterioration to MET activation was shortened and clinical outcomes were improved in hospitalized patients.

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