Get With The Guidelines Resuscitation National Webinar
Smart Strategies In Medical Emergency Teams: A clinical perspective
October 13, 2015 12pm Central Q&A
· You noted that peak MET calls occur during day (between 11a -7pm); why do you think MD's are not good at predicting deterioration of their patients when they make rounds?
I’m not convinced that’s what the data are showing. I think physicians probably aren’t the primary activators of the MET but that doesn’t mean they aren’t picking up on some of the signs of clinical deterioration. It’s likely that they are trying to intervene without additional help.
· How do you determine what a "typical" LOS is in the ICU, subsequently showing that there are cost savings with the use of the eCART and RRT?
In the study I presented we actually measured the actual length of stay. However, national averages are available. The following are published by the Society for Critical Care Medicine: http://www.sccm.org/Communications/Pages/CriticalCareStats.aspx
· What have you done to significantly improve clinical judgement among staff?
Our primary focus has been on creating a reproducible way to capture the judgment that our clinicians already have and it turns out that they’re pretty good without any additional specific training. However, we do conduct routine multidisciplinary debriefings of clinical deteriorations on the wards so our teams can continue to hone their skills.
· Why did you not include lactic acid levels or ABG's as a physiological measure for E-cart?
Great question. We know lactate is highly predictive but it is drawn so infrequently that we would end up imputing normal values too often. We used the bicarbonate value as a surrogate, which gets resulted with every chemistry panel. Then eCART becomes a risk stratification tool to help decide which patients should have a lactate. For example, all patients seen by RRT get screened for sepsis and those who meet criteria have a lactate drawn to decide next management steps.
· Where does the cloud based tool get the vital signs and LOC data?
The cloud based solution offered by Apervita, pulls data from the electronic health record or other administrative stream, such as the ADT feed, to calculate eCART in real time (https://apervita.com). eCART will also soon be available on the Philips Guardian System, which displays the score on the bedside monitor (http://www.healthcare.philips.com/main/products/patient_monitoring/products/intellivue_guardian_ews/).