Retrospective review of the Modified Early Warning Score in critically ill surgical inpatients at a Canadian Hospital
|
|
|
- Clifford Atkinson
- 8 years ago
- Views:
Transcription
1 Retrospective review of the Modified Early Warning Score in critically ill surgical inpatients at a Canadian Hospital Alisha Mills PGY 4 General Surgery Northern Ontario School of Medicine S
2 Disclosures S I have no financial/personal relationships to disclose
3 Background S Thunder Bay Regional Health Sciences Centre has a well established Medical Emergency Team (MET). S MET activated by single parameter track and trigger systems S Team consists of RN and MD, acts as Code Prevention Team
4 MET Calling Criteria Pt shows signs of acute change in: S S S S S Airway: S Threatened airway or Stridor or Excessive Secretions Breathing: S RR <8 or >30 or Distressed breathing or Sats <90% on 50% oxygen or 6LNC Circulation: S SBP <90 or >200 or decreased >40mmHg or HR <40 or >130 or Urine output <100mL in 4 hrs except dialysis pts Neurological: S Decreased LOC or GCS decreased greater than 2 Worried: S Serious concern about the pt
5 Background Critical Care Medicine, Dec 2009, Vol 37, No. 12, pp
6 Background S Is there a way to help multidisciplinary teams identify patients at risk of catastrophic deterioration? S Would a scoring system help decrease Code Blue events and catastrophic deterioration in surgical patients?
7 Modified Early Warning Score (MEWS) S Quick bedside tool S Uses already recorded parameters S Highlights patients at risk of deterioration S Allows for more vigorous monitoring or transfer to higher level of care before critical decline
8 MEWS HR < >129 Temp < >38.4 SBP < >199 RR < >29 LOC Alert Voice Pain Unrespo nsive
9 Potential Impact of MEWS S Gardner-Thorpe et al., S Assessed in 334 surgical patients and colorectal patients S 75% of patients transferred to ICU or stepdown had MEWS >4 S NNT 5 S Maupin et al., S Hospital-wide implementation of MEWS in a hospital in Cincinnati S 50% decrease in Code Blues S 200% increase in RRT calls Ann R Coll Surg Engl 2006;88: Jt Comm J Qual Patient Saf 2009;35(12):
10 Our Question S In surgical inpatients who were seen by the Medical Emergency Team (MET) and/or had Code Blue events: S What was their MEWS at the time of the event and in the preceding 48hrs? S Can this information be used to identify those patients who would have benefited from earlier intervention by MET?
11 Methods S Feasibility study, retrospective review of Medical Emergency Team calls from July 1, 2010 to July 1, 2011 to inpatients on surgical floors (3A, 3B) S Retrospective review of Code Blue calls from July 1, 2010 to July 1, 2011 for inpatients on surgical floors (3A, 3B, 3C, 3CN) S Assessment of MEWS at time of MET call and in 48hrs prior to MET call S Assessed 179 patients with 218 MET or Code Blue calls
12 Primary Outcome S MEWS at time of MET call and/or Code Blue event
13 Secondary Outcomes S Time between MEWS 5 and MET call S 30-day in-hospital mortality rate S Number of ICU admissions resulting from MET calls
14 Demographic Information Admitting Service Ortho General Surgery Hospitalist Family Med Gyne Urology Other
15 Indications for MET Call 40% 30% 20% 10% 0% % MET Calls % MET Calls
16 Results Sensitivity Specificity PPV NPV
17 MEWS Results MET MEWS Disposition 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% < 5 5 Missing Vitals 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% < 5 5 Ward ICU Deceased
18 Time between MEWS 5 and MET 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% Time: 4-12 hrs Time: hrs %
19 Results at MET call Variable MEWS <5 MEWS 5 Test P-value Age (median and range) Gender (male:female) 30-day mortality Disposition to ICU LOS (median and range) 72 (20-97) 76 (31-95) Mann-Whitney U test :57 50:49 Chi-square % 30.43% Chi-square % 38.38% Chi-square < (1-103) 15 (2-178) Mann-Whitney U test 0.003
20 Effect of MEWS in 4-12 hrs preceding MET call Variable MEWS <5 MEWS 5 Test P-value Age (median and range) 76 (20-97) 74 (31-93) Mann-Whitney U test Gender (male:female) 30-day mortality Disposition to ICU LOS (median and range) 66:85 4:3 Chi-square % 41.86% Chi-square < % 42.86% Chi-square (1-157) 17 (2-73) Mann-Whitney U test 0.456
21
22 Results S Less then half of MET calls reached MEWS calling criteria S Many patients exhibit signs of clinical deterioration before being seen by MET in the 4-48 hours prior to call S Statistically significant increase in disposition to ICU, 30- day in-hospital mortality and length of hospital stay with MEWS 5
23 Conclusions S Despite a well-developed MET team, many patient exhibit vital sign abnormalities suggestive of critical deterioration prior to their assessment by MET S MEWS identifies patients at risk of clinical deterioration prior to assessment by MET S Implementation of MEWS into pre-existing EMR could be used to identify patients at risk of deterioration
24 Limitations S Retrospective chart review S Depended on electronically charted vital signs S Level of consciousness not consistently charted S Mostly surgical inpatients
25 Future Directions of Research S Prospective hospital-wide implementation trial at Thunder Bay Regional Health Sciences Centre S MEWS will be implemented into EMR, will be automatically calculated S Algorithm for increasing MEWS will include alerting MRP and increased monitoring
26 Many Thanks To: S Dr. S. Zaki Ahmed S Dr. Alison Fox-Robichaud S Dr. Heather MacLeod S The Method Centre, Ottawa
27 Questions? S
28 References S S S S S Campello G et al., Immediate and long-term impact of medical emergency teams on cardiac arrest prevalence and mortality: a plea for periodic basic life-support training programs. Crit Care Medicine Dec 2009, 37(12): Ludikhuize J et al., Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score. J Crit Care 2012 epub /jcrc Subbe CP, Kruger M, Rutherford P, Gemmel L., Validation of a modified early warning score in medical admissions. Q J Med 2001;94: Gardner-Thorpe K et al., The value of modified early warning score (MEWS) in surgical inpatients: a prospective observational study. Ann R Coll Surg l 2006;88: Maupin JM, Roth DJ, Krapes RN., Use of modified early warning score decreases code blue events. Jt Comm J Qual Patient Saf 2009;35(12):
Ruchika D. Husa, MD, MS Assistant t Professor of Medicine in the Division of Cardiology The Ohio State University Wexner Medical Center
Modified Early Warning Score (MEWS) Ruchika D. Husa, MD, MS Assistant t Professor of Medicine i in the Division of Cardiology The Ohio State University Wexner Medical Center MEWS Simple physiological scoring
The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study
The Royal College of Surgeons of England GENERAL SURGERY doi 10.1308/003588406X130615 The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study J GARDNER-THORPE
Policy & Procedure Manual Administration - Role and Expectations of the Most Responsible Physician (MRP)
The Scarborough Hospital Policy & Procedure Manual Administration - Role and Expectations of the Most Responsible Purpose To clarify and standardize the role of the Most Responsible at The Scarborough
Adoption of the National Early Warning Score: a survey of hospital trusts in England, Northern Ireland and Wales
The UK s European university Adoption of the National Early Warning Score: a survey of hospital trusts in England, Northern Ireland and Wales Ugochi Nwulu, University of Kent Professor Jamie Coleman, University
Value of Modified Early Warning Score Among Critically Ill Patients
Med. J. Cairo Univ., Vol. 78, No. 1, December: 1-7, 2010 www.medicaljournalofcairouniversity.com Value of Modified Early Warning Score Among Critically Ill Patients ASHRAF HUSSEIN ABD AL MOHSEN, M.D. and
Rapid Response Teams and Early Warning Scores. Dawn Edwards
Rapid Response Teams and Early Warning Scores Dawn Edwards Saving children's lives Rapid Response Teams Saves Children s Lives at Pediatric Hospital, Stu Sharek, assistant professor at Lucile Packard Children
Poor performance of the modified early warning score for predicting mortality in critically ill patients presenting to an emergency department
Original Article 273 Poor performance of the modified early warning score for predicting mortality in critically ill patients presenting to an emergency department Le Onn Ho 1, Huihua Li 2, Nur Shahidah
Solution Title: Predicting Care Using Informatics/MEWS (Modified Early Warning System)
Organization: Peninsula Regional Medical Center Solution Title: Predicting Care Using Informatics/MEWS (Modified Early Warning System) Program/Project Description, including Goals: Problem: As stated in
A National Early Warning Score for the NHS
A National Early Warning Score for the NHS Professor Gary B Smith FRCA FRCP Centre of Postgraduate Medical Research & Education, School of Health and Social Care, Bournemouth University - from local data
Case Study: Using Predictive Analytics to Reduce Sepsis Mortality
Case Study: Using Predictive Analytics to Reduce Sepsis Mortality 1 Learning Objectives 1. Understand how an automated, real time IT intervention can help care teams recognize and intervene on critical,
Evaluation of the threshold value for the Early Warning Score on general wards
SPECIAL ARTICLE Evaluation of the threshold value for the Early Warning Score on general wards C.R. van Rooijen 1*, W. de Ruijter 2, B. van Dam 1 Departments of 1 Internal Medicine, and 2 Intensive Care,
Validation of a Modified Early Warning Score (MEWS) in emergency department observation ward patients
Hong Kong Journal of Emergency Medicine Validation of a Modified Early Warning Score (MEWS) in emergency department observation ward patients TS Lam, PSK Mak, WS Siu, MY Lam, TF Cheung, TH Rainer Objective:
Harnessing the Power of EHR Data to Improve Patient Outcomes: Yale New Haven Health System and the Rothman Index
Harnessing the Power of EHR Data to Improve Patient Outcomes: Yale New Haven Health System and the Rothman Index Joan Rimar, RN, DNSc Clinical Management Consultant, Strategic Analytics Yale New Haven
CENTRE OF DOCTORAL TRAINING IN HEALTHCARE INNOVATION, TRANSFER REPORT, 2012 1
CENTRE OF DOCTORAL TRAINING IN HEALTHCARE INNOVATION, TRANSFER REPORT, 2012 1 Performance of early warning scoring systems to detect patient deterioration in the Emergency Department Mauro Santos 1,2,
Early Warning Systems
HOSPITAL CHRONICLES 2012, VOLUME 7, SUPPLEMENT 1: 37 43 CARDIAC NURSING ROUNDTABLE Early Warning Systems Daphne Georgaka, RN, Maria Mparmparousi, RN, Michael Vitos, RN INTRODUCTION Coronary Care Unit,
Hospitalized children who suffer a cardiopulmonary
Pediatric Code Events: Does In-House Intensivist Coverage Improve Outcomes?* Christopher L. Carroll, MD, MS; Kathleen Sala, MPH; Daniel Fisher, MD; Aaron Zucker, MD Objectives: A change in our children
CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE
CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Obstetric Early Warning Score Guideline Implementation
Timely interventions are essential
Implementation of a real-time computerized sepsis alert in nonintensive care unit patients* Amber M. Sawyer, PharmD; Eli N. Deal, PharmD; Andrew J. Labelle, MD; Chad Witt, MD; Steven W. Thiel, MD; Kevin
Paediatric Advanced Warning Score (PAWS)
Paediatric Advanced Warning Score (PAWS) Prevention is better than cure. Spectrum of critical illness Ward level care HDU Care ICU Care Early admission may improve outcome ICU Outreach teams Medical Emergency
Trust Guideline for the use of the Modified Early Obstetric Warning Score (MEOWS) in detecting the seriously ill and deteriorating woman.
A clinical guideline recommended for use In: By: For: Key words: Written by: Supported by: Maternity Services. Obstetricians, Midwives and Midwifery Care Assistants. All women receiving care from maternity
Document Details Title. Early Warning Score Protocol for Community Hospitals and Prisons to detect the Deteriorating Patient
Document Details Title Early warning Score Protocol for community Hospitals and Prisons to Detect the Deteriorating Patient Trust Ref No 1558-29748 Local Ref (optional) Main points the document This protocol
The Newcastle upon Tyne Hospitals NHS Foundation Trust. National Early Warning Score (NEWS) Policy
The Newcastle upon Tyne Hospitals NHS Foundation Trust National Early Warning Score (NEWS) Policy Version.: 1.0 Effective From: 3 December 2014 Expiry Date: 3 December 2016 Date Ratified: 1 September 2014
Summary of EWS Policy for NHSP Staff
Summary of EWS Policy for NHSP Staff For full version see CMFT Intranet Contact Sister Donna Egan outreach coordinator bleep 8742 Tel: 0161 276 8742 Introduction The close monitoring of patients physiological
Implementation of a high volume, complex clinical pathway for cardiothoracic surgery patients in the intensive care unit.
Implementation of a high volume, complex clinical pathway for cardiothoracic surgery patients in the intensive care unit. Marion van der Kolk Surgeon/Intensivist UMC St Radboud, Nijmegen The Netherlands
Nurses Activate Inpatient Stroke Alerts Faster than Physicians and are Equally Competent at Identifying Stroke Patients versus Stroke Mimics
Nurses Activate Inpatient Stroke Alerts Faster than Physicians and are Equally Competent at Identifying Stroke Patients versus Stroke Mimics February 1, 2012 Pravin George,DO Christopher Newey, DO MS Dolora
Building an Emergency Response to Acute Stroke
Great Lakes Stroke Network August 2006 Building an Emergency Response to Acute Stroke Wende N. Fedder RN, BSN, MBA Director, Stroke & Neurovascular Services Alexian Brothers Hospital Network Elk Grove
Outline. Advanced Practice Providers in the Intensive Care Unit. Why utilize APPs in the ICU? 5/30/2013
Outline Advanced Practice Providers in the Intensive Care Unit Thomas Farley MS, NP Assistant Clinical Professor UCSF School of Nursing Why utilize APPs in the ICU Recent publications General review of
Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi
Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi What is EWS? After qualifying, junior doctors are expected to distinguish between the moderately sick patients who can be managed in the
Session Number 312 FAILURE TO RESCUE: BE PROACTIVE NOT REACTIVE
Content Description Session Number 312 FAILURE TO RESCUE: BE PROACTIVE NOT REACTIVE Linda Bucher, RN, PhD, CEN, CNE Staff Nurse Virtua Memorial Hospital Emergency Department Mt. Holly, NJ The purpose of
A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit
ORIGINAL RESEARCH A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit Benson S. Hsu, MD, MBA; Thomas B. Brazelton III, MD, MPH ABSTRACT Objective: To
MCGUlNTY GOVERNMENT PLAN TO REDUCE WAIT TIMES AT ONTARIO EMERGENCY ROOMS. Urgent Care Centers Demonstration Project
~ -...-..-... Backgrounder Renseignements Ministry of Health and Long-Term Care ~ Ontario Ministere de la Sante et des Soins de longue duree MCGUlNTY GOVERNMENT PLAN TO REDUCE WAIT TIMES AT ONTARIO EMERGENCY
Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements
Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements Salmaan Kanji, Pharm.D. The Ottawa Hospital The Ottawa Hospital Research Institute Conflict of Interest No financial, proprietary
Rapid Response Team Utilization of Modified Early Warning Scores to Improve Patient Outcomes
Minnesota State University, Mankato Cornerstone: A Collection of Scholarly and Creative Works for Minnesota State University, Mankato Theses, Dissertations, and Other Capstone Projects 2011 Rapid Response
GIZMO IDOLATRY OR PRACTICAL SOLUTION?
CRITICAL CARE SYNDROME SURVEILLANCE USING THE ELECTRONIC MEDICAL RECORD: GIZMO IDOLATRY OR PRACTICAL SOLUTION? WORK IN PROGRESS AT KAISER PERMANENTE: THE EDIP PROJECT Gabriel J. Escobar, MD Vincent Liu,
Early Warning Score - An Evaluation of the Network Marketing Case Study
Original article Accuracy of an expanded early warning score for patients in general and trauma surgical wards Tim Smith, Dennis Den Hartog, Tineke Moerman, Peter Patka, Esther M.M. Van Lieshout and Niels
Acutely ill patients in hospital. Recognition of and response to acute illness in adults in hospital
Issue date: July 2007 Acutely ill patients in hospital Recognition of and response to acute illness in adults in hospital NICE clinical guideline 50 Developed by the Centre for Clinical Practice at NICE
Board of Directors. 28 January 2015
Executive Summary Purpose: Board of Directors 28 January 2015 Briefing on the requirements for the Trust to comply with Hard Truths Commitments Regarding the Publishing of Staffing Data Director of Nursing
Integrating Defensive Monitoring in the General Care Unit to Improve Failure to Rescue Trends
Integrating Defensive Monitoring in the General Care Unit to Improve Failure to Rescue Trends February 2009 Author: Susan Bruey, RN BSEd MSN Contents Introduction.... 2 The Problem Acknowledged.... 3 Current
Lynda Richardson, RN, BSN Sepsis/Septic Shock Abstractor. No disclosures
Lynda Richardson, RN, BSN Sepsis/Septic Shock Abstractor No disclosures 1 2 3 Discuss data requirements -3 hour bundle -6 hour bundle Challenges and compliance issues Success 4 Based on the Surviving Sepsis
Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that this is the most up to date version
Policy No: RM64 Version: 4.0 Name of Policy: Use of the National Early Warning Score System in Adult Patients Policy Effective From: 30/07/2015 Date Ratified 27/07/2015 Ratified Resuscitation and Deterioration
Intro Who should read this document 2 Key Messages 2 Background 2
Classification: Policy Lead Author: Nathan Griffiths, Consultant Nurse Paediatric Emergency Medicine Additional author(s): N/A Authors Division: Salford Healthcare Unique ID: DDCPan04(14) Issue number:
PEWS: Pediatric Early Warning Signs, Rapid Response Team, Code Blue
PEWS: Pediatric Early Warning Signs, Rapid Response Team, Code Blue Royanne Lichliter BS, RN And Jodi Thrasher MS, CFNP, RN 2/4/09 You Could Be A Lifesaver TOO!! 2 Background/History The Children s Hospital
National Early Warning Score
National Early Warning Score National Clinical Guideline No. 1 Summary February 2013 National Clinical Effectiveness Committee (NCEC) The National Clinical Effectiveness Committee (NCEC) was established
4/18/14. Background. Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients. Background. Signs and Symptoms of Withdrawal
Background 1 Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Alyssa Cavanaugh, PharmD PGY1 Pharmacy Resident Children s Hospital of Michigan **The speaker has no actual or
The Implementation of a Paediatric Early Warning Tool for use within the Emergency Department and on Acute Paediatric wards
Stockport NHS Foundation Trust NHS Every patient The Implementation of a Paediatric Early Warning Tool for use within the Emergency Department and on Acute Paediatric wards SN Nicola Adshead SN Raynie
Field Trauma Triage & Air Ambulance Utilization. SWORBHP Answers
Field Trauma Triage & Air Ambulance Utilization SWORBHP Answers Presented by : Dr. Mike Lewell, Regional Medical Director Dr. Mike Peddle, Local Medical Director Introduction/History What s this all about?
Sepsis: Identification and Treatment
Sepsis: Identification and Treatment Daniel Z. Uslan, MD Associate Clinical Professor Division of Infectious Diseases Medical Director, UCLA Sepsis Task Force Severe Sepsis: A Significant Healthcare Challenge
Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients
Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Jennifer Kuhns, Pharm.D. Pharmacy Practice Resident Children s Hospital of Michigan **The speaker has no actual or potential
Reliability Testing of a Modified Early Warning Scoring (MEWS) Tool Presented By: Lexie Scarborough Futrell, MSN, RN, CCRN Lubbock, Texas, USA
Reliability Testing of a Modified Early Warning Scoring (MEWS) Tool Presented By: Lexie Scarborough Futrell, MSN, RN, CCRN Lubbock, Texas, USA Research Team: Erin Whitley, BSN, RN Jamie K. Roney, BSN,
Inpatient Code Sepsis March Update. Sarah Prebil
Inpatient Code Sepsis March Update Sarah Prebil 3 hour bundle Time is life Kumar et al. Crit Care Med 2006; 34:1589-1596 But Sarah, why are you harassing us about sepsis? Pilot Results 10 Code Sepsis pabents
National Early Warning Score. National Clinical Guideline No. 1
National Early Warning Score National Clinical Guideline No. 1 February 2013 The National Early Warning Score and COMPASS Education programme project is a work stream of the National Acute Medicine Programme,
Early Warning System Scores for Clinical Deterioration in Hospitalized Patients: A Systematic Review
Early Warning System Scores for Clinical Deterioration in Hospitalized Patients: A Systematic Review M. E. Beth Smith 1,2, Joseph C. Chiovaro 1,6, Maya O Neil 2,4,7,8, Devan Kansagara 1,2,6,7, Ana R. Quiñones
Creating a Checklist Culture Chris George, RN MS cgeorge@mha.org
Creating a Checklist Culture Chris George, RN MS cgeorge@mha.org Objectives Benefits of using checklists What makes a good checklist Creating a culture that supports checklists Why do we need checklists?
The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome
Biomedical & Pharmacology Journal Vol. 6(2), 259-264 (2013) The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome Vadod Norouzi 1, Ali
Functional Improvement for Heart Failure Patients After Left Ventricular Assistive Device Placement in a Free Standing Rehabilitation Hospital
Functional Improvement for Heart Failure Patients After Left Ventricular Assistive Device Placement in a Free Standing Rehabilitation Hospital Vittal R. Nagar, M.D, PhDc PGY II Mentor: Robert Nickerson,
One of the Institute of Medicine s 10 rules for health
MEDICATION RECONCILIATION TOOL A Practical Tool to Reduce Medication Errors During Patient Transfer from an Intensive Care Unit Peter Pronovost, MD, PhD, Deborah Baugher Hobson, BSN, Karen Earsing, RN,
Sue Carol Verrillo, RN, MSN, CRRN The Johns Hopkins Hospital November 14, 2014
Early Detection of Patient Deterioration Using Remote Patient Monitoring with Wireless Nurse Notification Sue Carol Verrillo, RN, MSN, CRRN The Johns Hopkins Hospital November 14, 2014 1 Why Remote Patient
Identification and Prevention Pressure Ulcers in the ED
Identification and Prevention Pressure Ulcers in the ED Evidence Based Practice Project UC Davis Medical Center s Nurse Residency Program Janine Taylor R.N., B.S.N. Peg Freitag R.N., B.S.N. Hospital Acquired
A New Partnership: The Power of the Collaboration between CNIO and CNO to Maximize Nursing's Use of Technology within the Healthcare Enterprise
A New Partnership: The Power of the Collaboration between CNIO and CNO to Maximize Nursing's Use of Technology within the Healthcare Enterprise Welcome Disclosures Today s presenters do not have any relevant
The Role of the Acute Care Nurse Practitioner: New Models for Acute Care Delivery in an Academic Medical Center
The Role of the Acute Care Nurse Practitioner: New Models for Acute Care Delivery in an Academic Medical Center March 22, 2012 Barbara Cashavelly MS, RN, AOCN Maria Winne MS, RN, NE-BC Massachusetts General
Epinephrine in CPR. The 5 Most Important EMS Articles EAGLES 2014. Epi vs No-Epi Take Homes 2/28/2014. VF/VT (1990 Pairs) Epi vs No-Epi
The 5 Most Important EMS Articles EAGLES 214 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN nephrine in CPR VF/VT
ESCMID Online Lecture Library. by author
Do statins improve outcomes of patients with sepsis and pneumonia? Jordi Carratalà Department of Infectious Diseases Statins for sepsis & community-acquired pneumonia Sepsis and CAP are major healthcare
Change Management for Health IT: Preparing for your Next Challenge
Change Management for Health IT: Preparing for your Next Challenge Krystyna Hommen BSc MBA President and CEO, Excelleris Technologies Laurie Poole BScN MHSA Vice President, Telemedicine Solutions, OTN
The 5 Most Important EMS Articles EAGLES 2014
The 5 Most Important EMS Articles EAGLES 2014 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN VanderbiltEM.com
The Role of the Advance Practice Clinician (APC) in Pediatric Trauma Care
The Role of the Advance Practice Clinician (APC) in Pediatric Trauma Care Lisa Runyon, MS, CPNP Primary Children s Hospital Salt Lake City, UT Objectives Describe the evolution of the Advanced Practice
What do ACO s and Hospitals want from SNF s and CCRC s
What do ACO s and Hospitals want from SNF s and CCRC s Presented to the Institute of Senior Living, April 11, 2013 A Division of Kindred Healthcare 1 Assessing the match: What hospitals and ACO s currently
PARAMEDIC TRAINING CLINICAL OBJECTIVES
Page 1 of 21 GENERAL PATIENT UNIT When assigned to the General Patient unit paramedic student should gain knowledge and experience in the following: 1. Appropriate communication with patients and members
THE ROYAL CORNWALL HOSPITALS NHS TRUST RESPONSE TO INFORMATION REQUEST. Date Request Received: 20 October 2014 FOI Ref: 567
FREEDOM OF INFORMATION ACT 2000 THE ROYAL CORNWALL HOSPITALS NHS TRUST RESPONSE TO INFORMATION REQUEST Date Request Received: 20 October 2014 FOI Ref: 567 Requested Information I would like to know whether
Non Emergency Transport (NET) For Physicians
Non Emergency Transport (NET) For Physicians What you need to know! This epresentation will take you approximately 25 minutes to complete START This training package is intended to guide physicians through
National Outreach Forum Operational Standards and Competencies for Critical Care Outreach Services
National Outreach Forum Operational Standards and Competencies for Critical Care Outreach Services Foreword Critical Care Outreach Teams (CCOT) are one of the great successes of the developments following
Prevention of Falls and Fall Injuries in the Older Adult: A Pocket Guide
INTERNATIONAL AFFAIRS & BEST PRACTICE GUIDELINES Prevention of Falls and Fall Injuries in the Older Adult: A Pocket Guide 2 Introduction to the Pocket Guide This pocket guide resource has been summarized
Improving the reporting of Medication Incidents. From Incident Reporting to Controls Assurance
Improving the reporting of Medication Incidents From Incident Reporting to Controls Assurance Quote Strive for perfection in everything you do. Take the best that exists and make it better. When it does
RECOGNISING AND RESPONDING TO CLINICAL DETERIORATION: USE OF OBSERVATION CHARTS TO IDENTIFY CLINICAL DETERIORATION
RECOGNISING AND RESPONDING TO CLINICAL DETERIORATION: USE OF OBSERVATION CHARTS TO IDENTIFY CLINICAL DETERIORATION MARCH 2009 1. INTRODUCTION There are observable physiological abnormalities prior to adverse
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and
High Risk Emergency Medicine
High Risk Emergency Medicine Minor Head Injuries in Patients on Oral Anticoagulants David Thompson, MD, MPH Assistant Professor Department of Emergency Medicine No relevant financial relationships to disclose
Using Predictive Analytics to Improve Sepsis Outcomes 4/23/2014
Using Predictive Analytics to Improve Sepsis Outcomes 4/23/2014 Ryan Arnold, MD Department of Emergency Medicine and Value Institute Christiana Care Health System, Newark, DE Susan Niemeier, RN Chief Nursing
Implementing a clustered acute stroke unit at a community hospital improves patient care
Implementing a clustered acute stroke unit at a community hospital improves patient care Linda Dykes, BScPT Manager, Sarnia Lambton District Stroke Centre Krista Steeves, BHScPT Physiotherapist, Bluewater
Peter Munk Cardiac Centre, University Health Network. Allied Health Personnel Symposium American Association of Thoracic Surgery April 26, 2014
The Expanding Role of the Nurse Practitioner and Physician Assistant Across the Continuum of Care for the CTS Patient: Preoperative, Postoperative, and After Discharge Jane MacIver RN NP PhD Peter Munk
Well-implemented Early Warning Scores can help Rapid Response Teams in improving outcomes
Well-implemented Early Warning Scores can help Rapid Response Teams in improving outcomes The intersection of deteriorating patients, Early Warning Scores, Rapid Response Teams and new monitoring technology
Interactive Voice Response Technology To Prevent Type 2 Diabetes in Cardiac Population
Interactive Voice Response Technology To Prevent Type 2 Diabetes in Cardiac Population Overview The University of Ottawa Heart Institute (UOHI) with an annual rate of 6000 admissions is committed to understanding,
SE5h, Sepsis Education.pdf. Surviving Sepsis
Surviving Sepsis 1 Scope and Impact of the Problem: Severe sepsis is a major healthcare problem that affects millions of people around the world each year with an extremely high mortality rate of 30 to
Guiding Protocolized Patient Care through Branching Logic. By Cindy Sparkman, BS, RRT-NPS and Mickey Roach, BS, RRT
Guiding Protocolized Patient Care through Branching Logic By Cindy Sparkman, BS, RRT-NPS and Mickey Roach, BS, RRT University of Utah 2 University of Utah FY2012 Hospitals and Clinics; 4 Hospitals 10 Community
Medication error is the most common
Medication Reconciliation Transfer of medication information across settings keeping it free from error. By Jane H. Barnsteiner, PhD, RN, FAAN Medication error is the most common type of error affecting
Benjamin M. Marlin Department of Computer Science University of Massachusetts Amherst marlin@cs.umass.edu January 21, 2011
Modeling and Prediction With ICU Electronic Health Records Data Department of Computer Science University of Massachusetts Amherst marlin@cs.umass.edu January 21, 2011 The Big Picture: History of Medical
Basic ATLS. The Primary Survey. Jason Smith MD DMI FRCS(Gen.Surg) Consultant Surgeon
Basic ATLS The Primary Survey Jason Smith MD DMI FRCS(Gen.Surg) Consultant Surgeon Trauma - expression comprising a spectrum of severity of mechanical violation of tissues, from a little scratch to a multiply
Health Services - A Review of the Ontario Medical Referral System
Centre for Studies in Family Medicine Patterns of Specialty Medical Referral Analysis of a Primary Health Care Electronic Medical Record Database Joshua Shadd, MD CCFP Bridget Ryan PhD Moira Stewart PhD
2/14/2015. Liz Cooke RN NP
Liz Cooke RN NP Quality of Life studies with HCT pts began at City of Hope in 1991 for Tool validation Retrospective Chart Review in 2000 of 100 HCT patients looking at readmission patterns. (published
Critical care outreach services and early warning scoring systems: a review of the literature
INTEGRATIVE LITERATURE REVIEWS AND META-ANALYSES Critical care outreach services and early warning scoring systems: a review of the literature Fiona McArthur-Rouse BSc MSc RGN Senior Lecturer, Acute Care
Rehabilitation within critical care. By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary
Rehabilitation within critical care By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary Contents Negative effects of Critical illness/ prolonged ventilation Evidence
General Practitioner
Palliative Care/End of Life Related Fees Service Type Fee code When to use General Practitioner Palliative Care Planning 14063 Once a patient living in the community (own or family home or assisted living;
THE IMPORTANCE OF SYSTEM INTEGRATION IN INTENSIVE CARE UNITS A Review
THE IMPORTANCE OF SYSTEM INTEGRATION IN INTENSIVE CARE UNITS A Review Rui Fonseca 1,2 and Pedro Pereira Rodrigues 1,3 1 Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto,
MINIMUM REQUIREMENTS OF AN ICU. Dr.Rubina Aman Module 1 MCCM
MINIMUM REQUIREMENTS OF AN ICU Dr.Rubina Aman Module 1 MCCM What is an ICU? A specialized section of a hospital that provides comprehensive and continuous care for critically ill patients, who can benefit
High Rehospitalization Rates: Evaluation and Impact
High Rehospitalization Rates: Evaluation and Impact May 29, 2009 Denise Remus, PhD, RN Chief Quality Officer, BayCare Health System BayCare Health System BayCare is the largest full-service, community-based
Does Depression affect compliance with CPAP therapy in patients with Obstructive Sleep Apnea? Ramesh Metta, MBBS M Jeffery Mador, MD
Does Depression affect compliance with CPAP therapy in patients with Obstructive Sleep Apnea? Ramesh Metta, MBBS M Jeffery Mador, MD Background Obstructive Sleep Apnea(OSA) Obstructive sleep apnea (OSA)
Caring About Palliative Care An overview
Caring About Palliative Care An overview Developed by the Palliative Care Consultation Team at VH and C. Talbot, Palliative Care Consultation Team at UH Presented by: Lee Ann Craig NP, Palliative Care
USE OF BUSINESS PROCESS MANAGEMENT TECHNOLOGY AND LEAN TO IMPROVE CARE
USE OF BUSINESS PROCESS MANAGEMENT TECHNOLOGY AND LEAN TO IMPROVE CARE Andrew Steele, MD, MPH, MSc Director of Medical Informatics Denver Health ehealth Services 660 Bannock St. Denver, CO 80204 Deborah
Kick off Meeting November 11 13, 2015. MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF)
Kick off Meeting November 11 13, 2015 MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF) Team Composition Justin Huynh, MD Internal Medicine, Physician Champion Mary Laubinger,
Care Coordination at Frederick Regional Health System. Heather Kirby, MBA, LBSW, ACM Assistant Vice President of Integrated Care
Care Coordination at Frederick Regional Health System Heather Kirby, MBA, LBSW, ACM Assistant Vice President of Integrated Care 1 About the Health System 258 Licensed acute beds Approximately 70,000 ED
Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design. Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer
Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer 0 Gap Between Knowledge and Delivery Translational Roadmap
Collected Input: Administrative Practices (Staffing/Service Volume & Staffing Mix)
Collected Input: Administrative Practices (Staffing/Service Volume & Staffing Mix) Original information from MDH worksheet is in orange highlight, italicized serif font. When original information is used