Hannah J Wong1, Rachel Bierbrier2, Philip Ma2, Sherman Quan3, Sannie Lai2, Robert C Wu4. 1. School of Health Policy and Management, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada. 2. University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. 3. Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, Ontario, L5B 1B8, Canada. 4. University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada; Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. Electronic address: robert.wu@uhn.ca.
Abstract
OBJECTIVE: To evaluate in patients who deteriorate and require transfer to the intensive care unit (ICU), how many have a critical text message communicating deterioration and what is the quality of this message? Is message quality, message response or the timeliness of rapid response team (RRT) activation related to death? METHODS: We conducted a retrospective chart review of all ICU transfers from General Internal Medicine (GIM) wards from January 2012 until August 2014. All critical messages (CM) in the 48h prior to ICU transfer were analyzed for RRT calling criteria, time to RRT activation, message quality, presence of vitals, and the quality and timeliness of physician response. RESULTS: Of the 236 patients in the study, 93 (39%) had a CM in the 48h prior to ICU transfer. Within this subset, 76 patients did not have prior RRT activation and the median times from CM to RRT activation and CM to ICU transfer were 8.9 [IQR 2.9, 20.7] and 15.6 [IQR 9.0, 28.7] hours, respectively. Only 45% of messages contained 2 or more vitals and only 3% of messages contained Situation, Background, Assessment, and Recommendations (SBAR). Physician response was timely (3 [IQR 2, 17] min) but response quality was poor; nearly one quarter of responses only acknowledged receipt. Among message characteristics, only the number of SBAR elements was correlated with in-hospital survival (p=0.047). CONCLUSION: Communication between nurses and physicians about critically ill patients could be improved. There appear to be significant gaps in the quality of messages, their responses, and delays in RRT activation.
OBJECTIVE: To evaluate in patients who deteriorate and require transfer to the intensive care unit (ICU), how many have a critical text message communicating deterioration and what is the quality of this message? Is message quality, message response or the timeliness of rapid response team (RRT) activation related to death? METHODS: We conducted a retrospective chart review of all ICU transfers from General Internal Medicine (GIM) wards from January 2012 until August 2014. All critical messages (CM) in the 48h prior to ICU transfer were analyzed for RRT calling criteria, time to RRT activation, message quality, presence of vitals, and the quality and timeliness of physician response. RESULTS: Of the 236 patients in the study, 93 (39%) had a CM in the 48h prior to ICU transfer. Within this subset, 76 patients did not have prior RRT activation and the median times from CM to RRT activation and CM to ICU transfer were 8.9 [IQR 2.9, 20.7] and 15.6 [IQR 9.0, 28.7] hours, respectively. Only 45% of messages contained 2 or more vitals and only 3% of messages contained Situation, Background, Assessment, and Recommendations (SBAR). Physician response was timely (3 [IQR 2, 17] min) but response quality was poor; nearly one quarter of responses only acknowledged receipt. Among message characteristics, only the number of SBAR elements was correlated with in-hospital survival (p=0.047). CONCLUSION: Communication between nurses and physicians about critically illpatients could be improved. There appear to be significant gaps in the quality of messages, their responses, and delays in RRT activation.
Authors: José Manuel Hernández-Padilla; Alda Elena Cortés-Rodríguez; José Granero-Molina; Cayetano Fernández-Sola; Matías Correa-Casado; Isabel María Fernández-Medina; María Mar López-Rodríguez Journal: Int J Environ Res Public Health Date: 2019-11-16 Impact factor: 3.390