Academic journal article Australian Health Review

Medical Emergency Response in a Sub-Acute Hospital: Improving the Model of Care for Deteriorating Patients

Academic journal article Australian Health Review

Medical Emergency Response in a Sub-Acute Hospital: Improving the Model of Care for Deteriorating Patients

Article excerpt

Introduction

The medical emergency team (MET) or rapid response team (RRT) has become a prevailing model of care in the management of deteriorating ward patients. Although its impact on patient outcomes remains controversial, it has been widely adopted in many acute care hospitals around the world, including Australia.1-5 Although the RRT and its functions have been extensively investigated in the setting of acute hospitals, reports of its role and effect on patient care and outcome in the sub-acute hospital setting are limited.

The sub-acute hospital setting has traditionally been used for patients with lower medical acuity, for example psychiatry, rehabilitation, agedand palliative care wards. However, changing models of care in these areas have meant that there is an increased need to manage unwell patients. This has resulted in the development of individual emergency response systems for different precincts within our health service, using available local resources, with the option to transfer the patient to the acute care facility and critical care beds as required. The medical emergency response (MER) call is the afferent limb in our subacute hospital.

Recent service changes at our subacute hospital have led to an increasing number of MER calls. Accordingly, we undertook a retrospective observational study of MER calls, to understand the nature of these RRT calls on our subacute campus. Specif- ically, we looked at the changes in MER calls over six financial years. In addition, we studied in detail the clinical triggers, characteristics and outcomes of patients subject to MER review over a 12-month period. Finally, we assessed aspects of limitations of medical treatment (LOMT) and appropriateness of escalation of care in the context of likely prognosis in these patients.

Methods

The hospitals

Austin Health is a major teaching and referral centre in the north- east of Melbourne and consists of three facilities: The Austin Hospital, Heidelberg Repatriation Hospital and Royal Talbot Rehabilitation Centre.

The acute campus

The Austin Hospital is a 400-bed tertiary acute care hospital with a 20-bed intensive care unit (ICU) and a mental health precinct with acute psychiatric facilities for adults, children and adolescents. The hospital is also home to the Victorian Spinal Cord Service, Victorian Liver Transplant Unit and the Victorian Respiratory Support Service. It provides all major medical and surgical services, including cardiothoracic and neurosurgery.

The sub-acute campus

The Heidelberg Repatriation Hospital (HRH) is a sub-acute hospital 1.6 km from the Austin Hospital. It provides elective surgery, in-patient services (aged care, palliative care, mental health) and outpatient services (outpatient clinics, radiation on- cology, dialysis, nuclear medicine and radiology).

Over the 7-year period since implementation of a MER at the HRH, the following changes in patient mix and acuity have occurred. First, a 30-bed elective surgery centre was opened in the 2008-09 financial year that provides overnight care for 12 patients. There is also a 104-bed aged care service with beds across multiple wards providing rehabilitation, acute and interim care. This includes a 24-bed acute geriatric unit that opened in the 2009-10 financial year to admit patients from the emergency department (ED) and acute medical wards at the Austin. Finally, the site also contains a 17-bed palliative care unit (PCU) and a 20-bed psychiatric unit for war veterans.

Clinical support services for deteriorating patients at the sub-acute campus

Access to intensive care

The HRH does not have an ICU or high dependency unit. Cardiac monitoring or non-invasive ventilation is also not avail- able on this site. Accordingly, if patients experience significant clinical deterioration they need to be transferred to the acute care campus.

Access to acute diagnostic services

There is only limited access to diagnostic services, especially outside normal working hours. …

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