Given the recent holiday shopping season, most of you are familiar with the acronym “BOGO” (Buy One, Get One). It turns out that with critical adverse events, if you have one on a med-surg unit you are also more likely to get another one!
Researchers at the University of Chicago analyzed data from 13 med-surg wards where rapid response teams were used and looked at cardiac arrests and urgent transfers to ICU’s (Volchenboum 2016). They found that in the 6-hour window following a cardiac arrest or urgent transfer to ICU, the likelihood of a second similar event increased 18%. And if 2 events occurred the likelihood of a third event on that ward increased 53%. These results remained statistically significant when the time window was changed to 3 hours or 12 hours after the first event.
The authors explained the findings by likely diversion of resources to critically ill patients, resulting in less attention to other patients on the ward. Anyone who has observed all the events taking place on a ward when a patient has a cardiac arrest or other critical event would not be surprised that less attention gets paid to other patients on the ward. But this is the first time, to our knowledge, that anyone has formally quantified this phenomenon.
The authors stress
that although the absolute increased risk was small, these events were
associated with high morbidity and mortality.
We don’t know what
the best solution for this issue is. Obviously, key personnel from the ward are
needed to work with the Rapid Response Team (or equivalent group of people
responding to a critical event) but there probably should always be clear
designation of someone to maintain surveillance over the remaining patients on
the ward. And that should be an element covered in
your training for Rapid Response Teams.
Our other columns on rapid response teams:
Volchenboum SL, Mayampurath A, Göksu-Gürsoy G, et al. Association between In-Hospital Critical Illness Events and Outcomes in Patients on the Same Ward (Research Letter). JAMA 2016; Published online December 27, 2016