REDUCTION IN IN-HOSPITAL CARDIAC ARREST WITH EARLY INTERVENTIONS IN THE EMERGENCY DEPARTMENT AND NON-ICU UNITS BY A NOVEL APPROACH OF RAPID RESPONSE TEAMS (RRT) AND MOBILE ICU MANAGEMENT

SESSION TITLE: Advances in Pulmonary and Critical Care Training SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 01:30 pm - 02:30 pm PURPOSE: To determine rates of hospital wide codes before and after implementation of a novel approach of Mobile ICU management in conjunction with RRT for the evaluation and early management of patients in the emergency department and non-ICU units in the hospital. METHODS: The study was conducted at Baylor St Luke's Medical center, an 850-bed quaternary and academic medical center in Houston, Texas. Patients in the emergency department and non-ICU units that met the criteria of decompensation were evaluated by RRT. RRT consisted of a team of experienced nurses specifically trained in medical emergency response. If needed, RRT requested immediate management by the Mobile ICU team which had extended scope of ICU interventions and was made up of a critical care attending physician, critical care fellow and a mid-level provider. The advanced ICU capabilities included obtaining point of care labs including lactic acid levels, portable ultrasound, airway management, and resuscitation capabilities such as placing central lines, rapid infusers and initiation of pressors. A mobile procedure cart was specifically built for this purpose and was stationed in the emergency department and in the hospital wards. Patients were transferred to the ICU as soon as beds became available. Retrospective analysis of a cohort of patients from January 2013 to September 2014 (Cohort A) when only RRT services had been rolled out, was compared with a cohort of patients from October 2014 to December 2017 (Cohort B) when Mobile ICU service was implemented as well. RESULTS: Cohort A had 305,999 patient days and Cohort B had 552,095 patient days. Hospital-wide codes reduced from 2.1 to 1.6 codes per 1000 patient days (p-value = 0.007). There was also significant reduction in the number of pulse-less electrical activity (PEA) arrests from 1.3 to 0.84 per 1000 patient days (p-value = 0.025). PEA codes in the emergency department dropped from 0.14 to 0.07 per 1000 patient days (p-value = 0.053). CONCLUSIONS: Significant decrease in overall code rates were observed after the implementation of the Mobile ICU team in conjunction with RRT. Specifically, significant reduction in PEA was noted. Added capabilities of the Mobile ICU team and early initiation of advanced therapies likely had the highest impact on the rate reduction observed. CLINICAL IMPLICATIONS: Prior studies have shown mixed results on the impact of RRT in reducing code rates with a large study showing no improvement. The novel approach of adding mobile ICU management to rapid response confers advanced capabilities that are not available to RRT. The approach was also to intervene early on patients in the emergency department where therapeutic delays adversely affect the outcomes. The decrease in PEA codes seen in this study likely signifies the effect of early intervention in preventable codes from septic shock, GI bleeding and respiratory failure. DISCLOSURES: No relevant relationships by Yao Ababio, source=Web Response No relevant relationships by James Herlihy, source=Web Response No relevant relationships by Christopher Howard, source=Web Response No relevant relationships by Babith Mankidy, source=Web Response No relevant relationships by Eddie Marfil, source=Web Response No relevant relationships by Christopher Morgan, source=Web Response No relevant relationships by Ali Omranian, source=Web Response No relevant relationships by Muhammad Siddique, source=Web Response No relevant relationships by PRAKRUTHI VOORE, source=Web Response