Rapid Respons Team works?

Reduction of cardiac arrests in hospitals in non-ICU area of 50% Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV, Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study, BMJ 2002; 324: 387-390

Reduction of admission in PACU (58%) and deaths (37%) Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates, Crit Care Med. 2004; 32: 916-921

Reduction of cardiac arrests before admission to ICU (4% vs 30%) Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A, The patient-at-risk team: identifying and managing seriously ill ward patients, Anesthesia. 1999; 54(9): 853-860

17% reduction of cardiac arrests (6,5 vs 5,4 per 1000 admissions) De Vita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL, Use of medical emergency team responses to reduce hospital cardiopulmonary arrests, Qual Saf Health Care. 2004; 13(4): 251-254

It is for this reason that the international literature available on the subject and the most recent worldwide guidelines for cardiopulmonary resuscitation are aimed at the prevention of the cardiac arrest by recognising the signs and symptoms that precede this extreme situation and the appropriate treatment. The different models developed in the world to respond to this type of need have recently been systemised into an implementational rapid response for emergencies called Rapid Response System (RRS). It is characterised by an “afferent arm” that can intercept the event acutely, and trigger a response based on the predefined criteria with an “efferent arm” consisting of highly qualified emergency response personnel and intensive care (Medical Emergency Team MET) with an adequate data collection system. The personnel in the wards must be able to monitor admitted patients with adequate instruments such as:

and scoring system for monitoring a patient’s condition and increases the attention to the patient, and when necessary, allows for timely activation of the MET (Medical Emergency Team. The MEWS, Modified Early Warning Score, provides an assessment of the systolic blood pressure, heart rate, respiratory rate, body temperature and level of consciousness using AVPU (Alert, Verbal, Pain, Unresponsive) allows for the early identification of deteriorating vital signs;

it allows for the early detection of the various stages of SEPSIS (SUSPECTED SEPSIS; DOCUMENTED SEPSIS; SEVERE SEPSIS; SEPSIS SHOCK) thanks to the interpolation of data from: the patients clinical condition / physiological parameters / blood

clinical prediction rule used to assess risk of adverse outcomes in patients presenting with pulmonary embolism. This score is calculated on the basis of the clinical information and physiological

parameters of the patient. Based on this score, the patient is assigned a degree of risk: Grade I Very low risk: 0-1.6% 30-day mortality / Grade II Low risk: 1.7-3.5% 30-day mortality / Grade III Intermediate Risk: 3.2-7.1% 30-day mortality / Grade IV High Risk: 4.0 -11.4% 30-day mortality / Grade V Very high risk:

early recognition of haemorrhagic shock, and its effects on the outcome have long been recognized. Traditional vital signs are relatively insensitive as early diagnostic markers of haemorrhaging, and as a result, the shock index (SI) - heart rate (HR) divided by systolic blood pressure (SBP) - has been suggested as more sensitive marker. The response team is activated by the “Track&Trigger” system, depending on the MEWS score obtained. In addition, the Sepsis/Severe Sepsis screening tool and PESI is an indispensable tool for recognizing and promptly addressing the critical situations introduced by SEPSIS and pulmonary Embolism and haemorrhaging.

The hospital may paradoxically fail in its overall management of critical events ranging from sudden deterioration, more or less rapid, of general conditions to cardiac arrest. The situation is often manifested by late intervention, be it resuscitation of a patient in their bed, in surgery or in the intensive care unit.Within hospitals the mortality rate from sudden cardiac arrests remains high. The incidents, based on the data of international literature, is between 1 – 5% admissions / year or 0.175 beds / year (Hodgetts, Resuscitation 2002 – Peberdy, Resuscitation 2003).

Much of the literature highlights that the prognosis of the intrahospital cardiac arrests, despite all the organisational efforts aimed at implementing an optimal response model, is still too often unfavourable; the survival rate for hospital discharge, worldwide, was about 14 – 18% for many years.

Patients developing an arrest in the hospitals general ward services have predominantly shown respiratory and metabolic derangements immediately preceding their arrest. Arrests are also frequently preceded by a clinical deterioration involving either respiratory or mental function.

The cardiac arrest, whilst representing the final stage of the most morbid events, must not be regarded as inevitable: the intrahospital cardiac arrest that occurs with normal hospitalised patients is not a sudden cardiac death in the majority of cases. Preceding this, in 75 – 80% of the cases there are abnormal physiological parameters and it is therefore potentially avoidable; the signs of clinical deterioration that evolve rapidly relating the cardiac arrest are present at least eight hours before the cardiac arrest and it is therefore essential to recognise them immediately.

Bellomo R, Goldsmith D, Uchino S, et al. A prospective before- and- after trial of a medical emergency team, Med J Aust. 2003, 179(6): 283‐287; The incidence of in -hospital cardiac arrest and death following cardiac arrest decreased after introduction of an intensive- care- based medical emergency team, as did overall hospital mortality

Before

63

37

163

1363

302

After

22

16

33

159

222

RRR 65% p=0,001

RRR 56% p=0,005

RRR 80% p=0,001

RRR 88% p=0,001

RRR 26% p=0,004

RRT Results

C.A.s number

C.A.s deaths

Total L.O.S. in ICU post-CA

Total L.O.S. in hospital Post-CA

Deaths during admissions

The most sophisticated intensive care often becomes unnecessarily expensive terminal care when the pre-ICU system failsPeter Safar, 1974

80% of patients who experience an in-hospital cardiac arrest have changes in vital signs eight hours prior to the event Schein RMH. Chest 1990; 98:1388‐1392

chemistry analysis • The Pulmonary Embolism Severity Index (PESI) is a

M.E.W.S.• MEWS – the MEWS (Modified Early Warning Score) model is a data collection

Sepsis Screening Tool

P.E.S.I.

Shock Index

10.0-24.5% 30-day mortality • Shock Index is an important indicator for the

• Sepsis / Severe Sepsis screening tool:

INTRODUCTION TO SMARTMEWS

Track and Trigger.

BR H

@H

_SM

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01

MADE INITALY

INNOVATION OF THE DEVICE

The H@H SMARTMEWS integrated system is the most advanced device in terms of medical technology for remote monitoring of vital signs and clinical data collection.

It represents the evolution of telemedicine with remote monitoring of vital signs and the collection of clinical data; facilitating the diffusion and the information for physicians, researchers and patients and offering direct care via the telemedicine device.

The device incorporates one multi parameter monitor (ECG, SaPO2 , Respiratory Rate - RR, two Temperature channels – T°, one channel for Non Invasive Blood Pressure measurement – NIBP), a complete computerized clinical chart that is able to be compiled and edited, as well as some automatic scores (Modified Early Warning Score – MEWS, Sepsis/Severe Sepsis screening tool, PESI, Shock Index, Glasgow Coma Scale – GCS, Glasgow Outcome Scale – GOS, Coma Recovery Scale- Revised – CRS-R, Sequential Organ Failure Assessment score

Track and Trigger.

H@H s.r.l.via le fogge 1170022 Altamura (BA) Italiat +39 080 3143647f +39 080 3160611www.hospitalathome.itinfo@hospitalathome.it

Numero Verde

800 148 775

Manufactured by ITEM OXYGEN s.r.l.H@H s.r.l., H@H smart mews and ITEM OXYGEN s.r.l. are registered trademarks.No part of this publication may be reproduced or used without authorization from H@H.Patented device and design.

in high definition. All the devices are connected via an intranet and centralised in the H@H SMARTMEWS Central Station in Intensive Care. The data obtained by monitoring the vital signs, processed with the information in the Computerised

then automatically sends alerts depending on the status of the various scores. Each of the H.R., R.R., SaPO2, T°, NIBP values are assigned a MEWS based score that is then totalled; if below 5 standard assistance protocol for the ward are applied, if = > 6 the Service Centre in Intensive Care is alerted and it activates (Trigger) the RRT (Rapid Response Team), made up of a anaesthetist and Intensive Care nurse, who immediately attend to the critical patient. This system creates extremely positive feedback in terms of mortality and morbidity as described in the literature, as we have seen, serious adverse events are pronounced at least 8 hours before they are

– SOFA Score etc.). Finally there is a channel for video communication

Central Station screeNnshots of H@H SMARTMEWS

are automatically processed by the onboard computer that

determined by significant changes in vital signs

Medical Chart through a process called “Track and Trigger”,