Who cares wins - Critical Care Symposium

Warrington Hospital Acute Care Team …who cares wins
Bower T, Sale T, Harmes N, Comara J, Boyle C, Lower N
And Warrington Hospital Acute Care Team
Introduction
In 2013 Warrington Hospital Acute Care Team- ACT became fully operational, 24/7.It
consists of 2 critical care outreach nurses, 4 trainee assistant practitioners (TAPs), 4
experienced intensive care nurses, 6 Night Nurse Practitioners (NNPs) and the Acute Care
Team matron.
The ACT developed andintroduced a Medical Emergency Team-MET in January 2014. We
took a novel approach, different from other Trusts and developed an Acute Care Nurse -led
2 tier MET. The 1st response team would be members of the ACT with junior doctors. If
required, the 2nd responders would be a senior doctor- anaesthetist, ICU doctor, medical
registrar or surgical registrar.
Methods
The calling criteria for MET was set at:
NEWS of 7,severeairway/respiratory/cardiovascular/neuro failure or any other serious
concern. Every MET call was audited. The audit included data on: calling criteria, assessment
on arrival of 1st responders and actions taken, requirement for 2 nd responders and outcomes
such as ICU admission. For the purpose of this study we were looking specifically at the
assessment of the patient by the MET and their immediate actions to see if our nurse led
MET model was robust.
Results
There were a total of 265 MET calls from Jan to June 2014. Audit data was available for 236
calls . 67 % of calls were at night, 33% during the day with a slight peak on Saturdays.
Only 1 call was for airway obstruction. Oxygen saturation ≤ 92(NEWS 3) was present in 51%
of cases. Systolic blood pressure ≤90 (NEWS 3 )was present in 12%.Heart rate≥130( NEWS
3)in 18% and respiratory rate≥25 (NEWS 3)in 44 % of cases. O2 therapy was either started or
increased in 63% of cases. IV fluids were started in 30% of cases.
The 2ndTier MET was required in 37% of cases: 24% required medical registrar, 8% required
ICU doctor. There was a decreasing need for medical registrar as MET developed: January
85%, February 31%,March25%,April 18 %,May 17% and June15%.
Discussion
Care of the deteriorating patient was ambition No.1 in a recent Keogh review A .The
development of the ACT in Warrington and the nurse led MET is our response to this
challenge. In keeping with other studies we too found that hypoxia was a major trigger and
supports the NEWS system B.Whereas many of these studies report on trigger criteria, we
concentrated on assessment of patients on arrival of the MET.
We found that the majority of deteriorating patients assessed by 1st tier MET were
low/medium risk and could be managed successfully by acute care nurse and Foundation
doctors. Only in 24%of cases was it felt necessary to call the 2nd tier medical registrar.
Significantly we found as time progressed the numberof 2nd tier calls reduced suggesting
increasing confidence of the 1st tier MET.
We will need to look further at outcomes but on the evidence of this audit looking at early
assessment it appears that a 2 - tier acute care nurse led MET is a safe and quality
alternative to the traditional medical registrar led MET. With reducing numbers of medical
trainees and increasing nurse specialisation we all need to consider new models of care a nd
we strongly recommend other Trusts to adopt our model …… the Acute Care Team .
A .Review into the quality of care and treatment provided by 14 hospital trusts in England:
overview report Professor Sir Bruce Keogh KBE 16 July 2013
B .Kause J et al. A comparison of antecedents to cardiac arrests, deaths and emergency
intensive care admissions in Australia and New Zealand and the United Kingdom-the
ACADEMIA study .Resuscitation 20014, 62:275-282.