Critical Care Rapid Response Team (CCRT) - Mount Sinai Hospital

Critical Care Rapid Response Team (CCRT)Information sheetReferred to as ACCESS (Acute Critical Care Emergency Support Service)at MSHMount Sinai Site Lead: Dr. Stephen LapinskyContact: x3211; slapinsky@mtsinai.on.caNursing Site Lead: Nurse Unit AdministratorContact x2610Background:- CCRT is also known as “Medical Emergency Teams” (MET)- Team comprises of a specially trained Critical Care nurse with a fellow and/or attendingphysician in support- Responds to deteriorating patients on the wards with the aim ofo Early intervention to avoid ICU requiremento Early referral and transfer to ICUo Education and support of ward staffo End-of-life discussion where appropriate- Used in Australia and England for more than 5 years- Piloted program at UHN, Oakville and Ottawa- MOHLTC now funding implementation in 22 hospitals province-wide- Expected outcomes:o Reduction in-patient arrestso Reduction in ward mortalityo Reduction in the ICU length of stayo Improved accessibility and utilization of ICU resourcesCCRT is NOT:- A replacement for the Cardiac Arrest Team- A substitute for an ICU consult- A substitute for medical consults

Calling Criteria: may be called by medical, nursing, respiratory and paramedical staffA- Airway concernsB- Respiratory rate 30, SaO2 50% oxygenC- Systolic BP 200, HR 30D- Decrease LOCO- Other serious concerns, decreased urine outputImplementationNovember 2006- January 2006: Initiation PeriodWeekdays 0800-1600 coverageFebruary 2007 onwards: Full implementation24-hour coverage, 7 days a week

Mount Sinai HospitalAccess Team‣ Ministry funded initiative in response to Safer Act Now‣ Team is made up of ICU nurses, RTs and MDs‣ Consult can be initiated by a RN, RT or Team physicians/housestaff‣ When RN/RT call the ACCESS TEAM, they must let the medical teamaware ASAP‣ Consults can be done from urgent situations like:-decreased LOC; hypotension-suspected sepsis-hypoxia-other urgent situations‣ The individual who responds to the call or consults will make a quick assessment,and take care of urgent issues i.e. assess airway, breathing, circulation, readschart, assess labs, DI and confers with the ICU physician on call- decide wherethe most appropriate place for the patient to be- ??? ICU, MSDU, or remain onthe ward‣ Individual will then help organize required care, immediate investigations,immediate treatment, urgent transfer required‣ Attending medical team must always be involved in management decisions‣ Team also provides outreach visit to patients who are recently discharged fromthe ICU‣ Part of the role of the ACCESS Team is to provide education for the units indealing with urgent situations‣ Remember: Access Team does not replace calling CODE BLUE. If a patient ishaving a cardiac or respiratory arrest, or the patient is in severe distress or airwayis compromised, CODE BLUE MUST BE ACTVATED BY THE STAFF

ACCESS Consult1. Primary Assessment• Airway: upper airway obstruction, stridor, secretionsRx: oral/nasal airway, jaw thrust, suction• Breathing: rate & effort, accessory muscles, SpO 2Rx: oxygen, nebulizer, bag-mask• Circulation: cyanosis, HR, BP, perfusionRx: IV access, fluid bolus, atropine, phenylephrine• Triage: Category A, B, C• Is this a code?• Is this an ICU consult? – need for intubation/inotropes2. Further Information• initiate monitoring• underlying disease/admission diagnosis• current episode – what happened?• review current medications• laboratory results and radiology if relevant3. Reassess - diagnoses & interventions to considerRESPIRATORY: COPD/asthma - nebulized CombiventPulmonary edema - LasixConsider CXR, ABGCARDIAC: Hypotension - bolus N/S 500 ml in 30 minBradycardia: atropineTachycardia: Rx hypotension, painChest pain: ASA, nitro, ECGSEPSIS: Fluid bolus, cultureNEURO: Decreased LOC: check glucose, D50W, ABGStroke: urgent Neuro opinion4. Communicate: ACCESS physician, ward team