liverpool hospital - rapid response systems
TRANSCRIPT
IMPLEMENTING RRTs and METsThe Journey – Liverpool Hospital
6th International Symposium on Rapid ResponseSystems and Medical Emergency Teams
Pittsburgh, USA, 11th-12th May 2010Ken Hillman
1982– CHARING CROSS
HOSPITAL, LONDON, UK
• 19 year old pillion passenger• Bled to death in the hospital
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LIVERPOOL HOSPITAL - 1988
• Several cases of preventable deathson general wards
• Discussions with Intensive Care Unitcolleagues
• Name - Medical Emergency Team
MET CRITERIA
33 → 3 vital signs3 observationsWORRIED
LIVERPOOL HOSPITAL
SURGEONS - easyPAEDIATRICS and O & G - easyMEDICINE - ???
CRITICAL POINT– Departmental Meeting
CRITICAL POINT“Cause celebre”
MARKETING
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LIVERPOOL HOSPITAL
• 300 beds• General, metropolitan hospital• Centre of huge population growth• Sleepy
ADMINISTRATION• General Manager• Medical Superintendent• No committees• No quality assurance committees• No business speak
TEACHING HOSPITAL STATUS- 1992
ACADEMICSINCREASE
CommitteesAdministrationStaff
CRITICAL POINTResearch and Publications
MET – FIRST PUBLICATIONS
DESCRIPTIVE• Lee A, Bishop G, Hillman KM. Daffurn K. The
medical emergency team. Anaesth Intensive Care1995;23(2):183-6
• Hourihan F, Bishop G, Hillman KM, Daffurn K, Lee A.The medical emergency team: A new strategy toidentify and intervene in high risk patients. ClinIntensive Care 1995;6(6):269-72
CRITICAL POINT
Health Minister announcesevery hospital in the State will
have the system
METRESISTANCE FROM WITHOUT
Spread around the world inverselyproportional to distance from
Liverpool Hospital
CRITICAL POINT (CHAMPIONS)
• Rinaldo Bellomo – Austin Hospital,Melbourne
• Julian Bion - Outreach Program - UK• Michael DeVita - Pittsburgh
OPPORTUNITIES FORWIDER IMPLEMENTATION
• Girl hit by golf ball - NSW• SARS epidemic - Ontario
VARIATIONS• Name of systems• Calling criteria• Response• Facilitators / blockers within
hospital
RESEARCH EVIDENCE
Often reinforces underlyingprejudices
MERIT STUDY
• Underpowered• Many reasons for not showing a
difference
Lancet 2005;365:2091-2097
META ANALYSIS• Reduction in cardiac arrests in paediatric hospitals
– 30%• Reduction in cardiac arrests in adult hospitals
– 30%• Reduction in deaths in paediatric hospitals
– 20%
“ We don’t believe there is yet enough evidence tosupport rapid response systems”
Arch Intern Med 2010;170:18-26
MERIT STUDYReduction in mortality in
Medical Emergency Teamhospitals
CCM 2010;38:700
Hospital SizeComplexity/“Standing”Infrastructure
Ease of Whole Hospital SystemImplementation
LIVERPOOL HOSPITALCULTURAL CONDITIONS
Transition to teaching hospital Limited bureaucracy Limitednumber of medical colleagues Reputation as iconoclastic
• Devolved ICU nursing responsibilities• ARC course• Day of surgery admission system
IT COULD PROBABLY NOT HAPPEN NOW