Brandon Chaffay, MD
George Washington University Hospital
Washington, District of Columbia
Disclosure information not submitted.
Aditi Ghatak-Roy, MD
Dr
George Washington University Hospital, United States
Disclosure information not submitted.
Amanda Roberson
RN
George Washington University Hospital, United States
Disclosure information not submitted.
Lia Losonczy, MD
Assistant professor
George Washington University Hospital, United States
Disclosure information not submitted.
Title: Medical Alert Protocol Initiation to Improve Effectiveness of Medical Resuscitations
Introduction/Hypothesis: Time to coordinate a team-based approach prior to a resuscitation has been shown to be an invaluable step in cardiac arrest care. We created a “Medical Alert” protocol to assemble the key members of our resuscitation team prior to the arrival of critically ill patients beyond solely cardiac arrests in the ED to allow for this coordination. The goal of this study was to assess if this specific protocol can improve overall team resuscitation organization, subjective resuscitation outcomes, and decrease associated barriers to effective responses.
Methods: The “Medical Alert” for critically ill patients was activated based on pre-hospital description or triage evaluation of ongoing CPR, ROSC, significant respiratory distress, shock, GCS < 8, ongoing seizure, or attending physician clinical gestalt. A pre-intervention survey was sent out to all ED clinical staff prior to implementation of the protocol at a large urban academic level I trauma center. After a period of 2 months post-intervention survey data was collected. A Likert scale, graded 1-5, and a subsequent Welch’s T-test assessed ordinal data given the assumption of unequal variances and a α-error of 5%. For nominal categorical variables a Chi-Square analysis was utilized with percentages indicating percent responders denoting a specific concern.
Results: The respondents (n=51 pre-, n=38 post-intervention) felt the protocol allowed more time to identify roles (3.02 v 3.56; p=0.03) and led to more effective resuscitations (4.02 v 4.31; p=0.04). This was noted to be independent of all team members being present in a timely manner (3.78 v 4.00; p=0.27). However, the presence of the respiratory therapist was significantly improved (74.5% v 42.1%; p< 0.01). The protocol was felt to allow for more time to prepare (36.5% v 15.9%; p=0.03), enhanced equipment availability (49.0% v 26.3%; p=0.03), clearer team roles (34.6% v 15.8%; p< 0.05), and for more space by designating a specific resuscitation room (46.2% v 23.7%; p=0.03).
Conclusions: This protocol allowed for improved time for communication and organization of team members as well as the perception of more effective resuscitations for critically ill patients beyond solely cardiac arrests. Further objective research is necessary to assess if this protocol leads to improved patient outcomes.