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Toronto (Nov. 26, 2007) - Creating a dedicated "SWAT-like" team of intensive care specialists who respond quickly to calls for help throughout the hospital can help decrease heart attacks and deaths, and prevent patients from deteriorating so that they must go on mechanical breathing devices.
Data gathered from May 2005 to May 2006 on the impact of the Critical Care Response Team on 342 patients in Toronto General Hospital, University Health Network (UHN) showed that there was a seven percent reduction in heart attacks and a 25% reduction in respiratory arrests (when patients stop breathing and need mechanical assistance to breathe).This translates to about 80 lives saved in one year – lives which otherwise would have been lost due to deteriorating conditions of patients. The data also showed that after the critical care team intervened, 71% of patients were able to remain on the ward, and 21% were transferred to the ICU. Others were transferred to units with more intense care than the wards.
"Our team is a portable intensive care unit (ICU) which responds within minutes to a call for help. By responding quickly, we can prevent patients from getting so sick that their heart stops or they stop breathing. We can even prevent a patient from requiring intensive care. Despite what television or the movies show, if a patient's heart stops while in the hospital, the chances of survival are poor – about 12%," says Dr. Stuart Reynolds, an ICU physician at UHN who is also the Ontario physician lead in expanding this program throughout the province. Dr. Reynolds pointed to a 2002 British Medical Journal article which found that medical dramas on television inflate two to six times the survival rates of patients who are revived after having a heart attack in a hospital.
A Critical Care Response Team is composed of an ICU physician, nurse, and respiratory therapist, and the teams are available 24 hours a day. Every patient who is discharged from the ICU into the ward is automatically followed for 48 hours, and staff are educated about any symptoms which would indicate that the patient's condition is worsening.
"We provide that extra set of eyes and ears to help the teams on the wards," says Mugs Zweerman, an ICU nurse who has volunteered with a Critical Care Response Team from the beginning. "We're a welcome resource for staff who feel more secure because they can say, 'Hi Mugs, can you just take a peek, I'm worried about this patient.'" Mugs also noted that the team is another resource for the families of patients, providing continuity of care, especially when a patient has previously been in the ICU for a long time.
One patient who is especially grateful for the team's services is Kevin Leonard, who was not responding to treatment after his surgery for a perforated bowel. His blood pressure dropped to dangerous levels, and the ICU outreach team was called. Within 15 minutes, they provided medication to stabilize his blood pressure. That saved him from being put on a ventilator to help him breathe. Although Kevin was admitted into the ICU for followup, his stay was shorter because of the early intervention of the team.
"I would not be here today if not for the team and the ward nurse who called them," says Kevin, adding that, "the team even followed me through part of my hospital stay to make sure I was doing well." Sandra, his wife, adds, "The team provided tremendous support in explaining everything from the severity of the situation to how things work in an ICU. In the midst of so much stress, the team members were calming and provided a friendly face to focus on. They made a huge difference to both Kevin and me."
Dr. Reynolds also noted that UHN is in the forefront of developing tools to help the Critical Care Response Team raise awareness of hospital staff about what they are able to do, and how they can help bring the expertise and resources of a critical care unit beyond its walls to meet patients' needs anywhere in the hospital. "Imagine the impact such teams could have across Ontario by bringing to patients the critical care skills, knowledge and equipment when and where it is needed."
To date, 27 larger hospitals with the bulk of critical care units have received funding from the Ministry of Health and Long Term Care to create the Critical Care Response Teams in each hospital, as part of Ontario's Critical Care Strategy. The team at TGH is called the Critical Care Outreach Team (CCOT). The sites are collecting data to establish benchmarks for teams across Ontario.
The Critical Care Strategy consists of a 7-part program to improve critical care access, quality and seamless co-ordination of services, with Ontario-wide projects on establishing best practices in ICUs, e-learning critical care training programs, end-of-life communications courses, information systems and other novel initiatives.
UHN's intensive care units provide support to the medical and surgical services at two sites: the General and Western. The focus is on solid organ transplantation (lung, liver, intestine), thoracic, vascular, neuro and cardiac surgeries, orthopaedics, general surgery and general internal medicine. Both sites have some of the most complex cases in the country. TGH is one of the few programs in Canada that provides external life-sustaining support for patients with lung and liver diseases via the Novalung and MARS. In addition to providing consultations in critical care, there is a Critical Care Response Team program at each site, providing support to discharged ICU patients, and assisting other healthcare providers with patients outside the ICU who show signs of instability. The Critical Care Response Team also provides support to patients' families.
Toronto General Hospital is a partner in the University Health Network, along with the Toronto Western Hospital and the Princess Margaret Hospital. These research hospitals are affiliated with the University of Toronto. The scope of research at Toronto General Hospital has made this institution a national and international source for cardiovascular discovery, education and patient care, as well as for its innovations in transplantation, critical care, cardiology, surgical innovation, infectious diseases, diabetes and genomic medicine.
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