.jpg "Marilyn Hravnak, PhD, RN photo")
Marilyn Hravnak, PhD, RN
Professor Emeritus
University of Pittsburgh
Pittsburgh, Pennsylvania
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Gilles Clermont, MD, MS
Professor CCM, Mathematics, Clinical Translational Sci and IE
VA Pittsburgh Health System
Pittsburgh, Pennsylvania
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Stephanie Helman, CCRN-K, CNS, MSN, RN
Predoctoral Research Fellow
University of Pittsburgh
Pittsburgh, Pennsylvania
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Tiffany Pellathy, ACNP, PhD, RN
Post-doctoral Fellow
Veterans Administration, Center for Health Equity Research and Promotion, United States
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Theodore Lagattuta, BSN, RN
Staff Researcher
University of Pittsburgh, School of Nursing, United States
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Melissa Saul, MS
Clinical Data Scientist
University of Pittsburgh School of Medicine, United States
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Betsy George, CCRN, MSN, PhD, RN
Programmatic Nurse Specialist
University of Pittsburgh Medical Center, United States
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Michael Pinsky, MD, Dr hc,MCCM
Professor Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology
University of Pittsburgh School of Medicine, United States
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Salah Al-Zaiti, PHD, RN, ANP-BC, FAHA
Associate Professor
University of Pittsburgh School of Nursing, United States
Disclosure information not submitted.
Title: Medical Emergency Team Calls for Ward Patients After Down-Transfer From An ICU
Introduction/Hypothesis: Patients are down-transferred from ICUs to hospital wards when deemed stable for ward care. Medical Emergency Team (MET) calls bring critical care services to unstable ward patients. We hypothesized that MET call characteristics would differ between ward patients down-transferred from an ICU and those not in an ICU before ward admission.
Methods: The study unit was a 24-bed surgical-trauma ward in an urban tertiary care center, with flexible monitoring capacity (hardwire/telemetry/none), and average nurse to patient ratios of 1:4-6. MET calls between 04/2018 and 10/2020 were identified from call logs. MET criteria were based on critical vital sign and consciousness changes, or nurse concern. We obtained MET call causes from event notes and categorized as primarily cardiovascular (CV), respiratory (RESP) or neurologic/psychiatric (NP). Patient location before ward admission was obtained from hospital Admission/Discharge/Transfer records. Patients were included if their MET log, event note and location data were all available.
Results: 114 patients had MET calls (mean age 64±17y; 61% male) with CV 47%, RESP 28%, or NP 25% causes. 58% of calls occurred in patients who were down-transferred from an ICU. Ward patients admitted from ICU vs non-ICU had similar MET cause (CV 51% vs 40%, RESP 29% vs 27%, NP 20% vs 33% respectively, p=0.233) and median time from ward admission to MET call (63 vs 70 hrs). After MET, 64% of MET patients were up-transferred from the ward to an ICU (44% returning to ICU). For MET calls within 48 hrs of ward admission (n=51/114, 45%), those down-transferred from an ICU (n=30/51, 59%) had significantly more RESP call cause vs non-ICU (CV 37% vs 52%, RESP 47% vs 5%, NP 16% vs 43% respectively, p=0.004), with median time from ward admission to MET call 18 vs 10 hrs respectively.
Conclusions: In this sample, patients down-transferred to the hospital ward from an ICU comprised more than half of all MET calls. For MET calls within 48 hours of ward admission, the majority comprised patients down-transferred from an ICU, and who had a respiratory cause. Our ability to judge patient stability for ward care is imperfect. Research to identify future instability risk and better inform triage of patients to an appropriate level of care and surveillance is needed.
Funding: R01NR013912