Download Mount Sinai Hospital Access Team

Critical Care Rapid Response Team (CCRT)
Information sheet
Referred to as ACCESS (Acute Critical Care Emergency Support Service)
at MSH
Mount Sinai Site Lead: Dr. Stephen Lapinsky
Contact: x3211; [email protected]
Nursing Site Lead: Nurse Unit Administrator
Contact x2610
Background:
- CCRT is also known as “Medical Emergency Teams” (MET)
- Team comprises of a specially trained Critical Care nurse with a fellow and/or attending
physician in support
- Responds to deteriorating patients on the wards with the aim of
o Early intervention to avoid ICU requirement
o Early referral and transfer to ICU
o Education and support of ward staff
o End-of-life discussion where appropriate
- Used in Australia and England for more than 5 years
- Piloted program at UHN, Oakville and Ottawa
- MOHLTC now funding implementation in 22 hospitals province-wide
- Expected outcomes:
o Reduction in-patient arrests
o Reduction in ward mortality
o Reduction in the ICU length of stay
o Improved accessibility and utilization of ICU resources
CCRT is NOT:
-
A replacement for the Cardiac Arrest Team
A substitute for an ICU consult
A substitute for medical consults
Calling Criteria: may be called by medical, nursing, respiratory and paramedical staff
A- Airway concerns
B- Respiratory rate <8, >30, SaO2 <90% on >50% oxygen
C- Systolic BP <90, >200, HR <40, >30
D- Decrease LOC
O- Other serious concerns, decreased urine output
Implementation
November 2006- January 2006: Initiation Period
Weekdays 0800-1600 coverage
February 2007 onwards: Full implementation
24-hour coverage, 7 days a week
Mount Sinai Hospital
Access Team
¾
¾
¾
¾
Ministry funded initiative in response to Safer Act Now
Team is made up of ICU nurses, RTs and MDs
Consult can be initiated by a RN, RT or Team physicians/housestaff
When RN/RT call the ACCESS TEAM, they must let the medical team
aware ASAP
¾ Consults can be done from urgent situations like:
-decreased LOC; hypotension
-suspected sepsis
-hypoxia
-other urgent situations
¾ The individual who responds to the call or consults will make a quick assessment,
and take care of urgent issues i.e. assess airway, breathing, circulation, reads
chart, assess labs, DI and confers with the ICU physician on call- decide where
the most appropriate place for the patient to be- ??? ICU, MSDU, or remain on
the ward
¾ Individual will then help organize required care, immediate investigations,
immediate treatment, urgent transfer required
¾ Attending medical team must always be involved in management decisions
¾ Team also provides outreach visit to patients who are recently discharged from
the ICU
¾ Part of the role of the ACCESS Team is to provide education for the units in
dealing with urgent situations
¾ Remember: Access Team does not replace calling CODE BLUE. If a patient is
having a cardiac or respiratory arrest, or the patient is in severe distress or airway
is compromised, CODE BLUE MUST BE ACTVATED BY THE STAFF
ACCESS Consult
1. Primary Assessment
•
•
•
•
Airway: upper airway obstruction, stridor, secretions
Rx: oral/nasal airway, jaw thrust, suction
• Breathing: rate & effort, accessory muscles, SpO2
Rx: oxygen, nebulizer, bag-mask
• Circulation: cyanosis, HR, BP, perfusion
Rx: IV access, fluid bolus, atropine, phenylephrine
Triage: Category A, B, C
Is this a code?
Is this an ICU consult? – need for intubation/inotropes
2. Further Information
•
•
•
•
•
initiate monitoring
underlying disease/admission diagnosis
current episode – what happened?
review current medications
laboratory results and radiology if relevant
3. Reassess - diagnoses & interventions to consider
RESPIRATORY: COPD/asthma - nebulized Combivent
Pulmonary edema - Lasix
Consider CXR, ABG
CARDIAC: Hypotension - bolus N/S 500 ml in 30 min
Bradycardia: atropine
Tachycardia: Rx hypotension, pain
Chest pain: ASA, nitro, ECG
SEPSIS: Fluid bolus, culture
NEURO: Decreased LOC: check glucose, D50W, ABG
Stroke: urgent Neuro opinion
4. Communicate: ACCESS physician, ward team