The effect of clinical alert system (CAS) and medical emergency team (MET) for hospitalized patients is controversial. Failure to timely activate MET and ineffective MET function after activation have been criticized. The study aims to propose an active way to implement CAS by the hospitalist system.
The study was conducted in National Taiwan University Hospital (NTUH), a 2000‐bed tertiary medical center in northern Taiwan. Hospital‐initiated CAS has been implemented in NTUH since 2005. Active implementation of CAS by hospitalist system was conducted in a 35‐bed general medicine ward managed by hospitalists since Oct 2009. All the patients were admitted from emergency department (ED) for acute care. To minimize neglect of activation, CAS criteria were routinely screened in every 8‐hr shift by nurse practitioners and called hospitalists on duty for management. The clinical alert event was reported on a shift basis, which was continued until the reason of activation resolved. After a 3‐month education period, we prospectively record every CAS report and night shift calls to duty residents (11pm to 8am) from Jan 2010. The study endpoints were night shift calls, intensive care unit (ICU) admission, and unexpected cardiopulmonary resuscitation. Data of year 1 (2010) and year 2 (2011) were compared.
From Jan 2010 to Dec 2011, a total of 2445 general medical patients (1331 in 2010 and 1114 in 2011) were admitted. Hospital mortality in 2010 and 2011 was 9.1% and 8.5%, respectively. DNR case number in 2010 and 2011 was 239 (18.0%) and 204 (18.3%), respectively. After active implementation, CAS report increased from 0.8% (290/36105) of patient‐shift in 2010 to 1.4% (527/37770) of patient‐shift in 2011. The night shift calls decreased by 30.8%, from 41.9 calls per month in 2010 to 29.0 calls per month in 2011. All‐cause ICU admission decreased by 34.6% (52 patient census in 2010 vs. 34 patient census 2011). Unexpected CPR events decreased by 60% (2.5 events per season in 2010 vs. 1.0 events per season in 2011). There was no unexpected CPR in the last 5 months of 2011.
Active implementation of CAS by hospitalist mitigates the night shift event, call workload and unexpected CPR. Timely activation with effective management is essential for a successful clinical alert system, which may be improved by the hospitalist system with 24/7 coverage.
To cite this abstract:Hsu N, Tsai H, Shu C, Lin Y, Ko W. Active Implementation of Clinical Alert System and Management by Hospitalists Mitigate Night Shift Call Workload and Unexpected Cardiopulmonary Resuscitation. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 143. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/active-implementation-of-clinical-alert-system-and-management-by-hospitalists-mitigate-night-shift-call-workload-and-unexpected-cardiopulmonary-resuscitation/. Accessed April 2, 2020.