Medical emergency management in hospitals: there is a need for action

Interview with Prof. Thea Koch, Director of the Clinic and Polyclinic for Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus Dresden

11/08/2016

Emergency situations do not just occur outside the hospital - life-threatening situations can also take place in patient rooms. Aside from the intensive care units, this also pertains to general hospital wards, where patients are not as closely monitored. Nursing staffs need to pay special attention in this case because emergencies sometimes announce themselves with certain symptoms.

Image: Smiling woman with long dark hair and a physician's coat; Copyright: University Hospital Dresden

Prof. Thea Koch; © University Hospital Dresden

In this interview with MEDICA-tradefair.com, Prof. Thea Koch talks about how nursing staffs in wards might possibly be able to recognize imminent emergencies, how medical emergency teams fly into action and how hospitals can implement emergency management.

Prof. Koch, German hospitals annually handle approximately 93,000 cardiac arrests. Are critically ill patients actual safe in these settings?

Prof. Thea Koch: The statement that one is not safe in hospitals is certainly not correct, but there is a need for action when it comes to emergency management. One European study showed that the patient mortality rate after surgical treatment is on average at around four percent and at 2.5 percent in Germany. Having said that, patients who die are frequently not located in intensive care units but rather in general hospital wards. Here, symptoms that point to a worsening of a patient’s condition are not always recognized in time. This is why we need so-called medical emergency teams or METs, who are immediately called in and are able to intervene at an early stage if the patient’s condition worsens.

What might be some of these displayed symptoms?

Koch: They can reveal themselves in many different ways, for instance, when a patient no longer answers appropriately or is disoriented, if he has respiratory problems, for instance, if breathing becomes too fast or too slow due to airway obstruction, if blood pressure or heart rate fluctuates or if the patient has a fever. In this case, the staff does not only rely on its own experience to recognize these situations but is also assisted by innovative medical technology. We are currently conducting a pilot study that deals with non-invasive respiratory monitoring and various systemic circulation parameters. We also include the automatic alerts of medical staff into this.

Image: Blurred image of hospital employees who run along a corridor; Copyright: panthermedia.net/SimpleFoto

Medical emergencies can also happen at regular station of hospitals. They can be averted by training the staff for early recognition of warning signs; © panthermedia.net/SimpleFoto

What life-threatening complications or emergency situations, respectively, do the teams need to be ready for?

Koch: Cardiovascular and respiratory emergencies are the most frequent cases that lead to cardiac arrest. Having said that, the spectrum of possible emergency situations in a hospital is very wide: this includes a worsening of pre-existing medical conditions, secondary hemorrhage after surgeries, thromboses, or embolism, dehydration after excessive loss of bodily fluids, pulmonary or metabolic issues or medication allergy reactions.

What exactly are the duties and responsibilities of METs and medical emergency management?

Koch: It is crucial for the ward staff to alert the MET early based on defined early warning criteria. The team’s role subsequently consists of promptly treating the symptoms and transferring patients to the intensive care unit if necessary. This needs to happen even before there is a cardiac arrest and the resuscitation team needs to be called in.

In turn, the task of medical emergency management is to train the hospital ward and nursing staff to where they are able to identify these early warning criteria and even take resuscitative measures themselves until the MET arrives.

To what extent are METs utilized today in hospitals?

Koch: We conducted a survey on the state of medical emergency management in German hospitals. Of the hospital facilities that responded, 90 percent provide a resuscitation team, yet only 22 percent of hospitals have a MET that is being alerted based on defined early warning criteria that usually occur hours before the apparent life-threatening event actually takes place.

Ten percent of hospitals need to alert an external emergency medical service for emergencies or they leave emergency measures in the hands of the team in the ward.

That’s why we at the German Society of Anesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin), DGAI, have launched a task force to establish the comprehensive use of METs since we recognized there is a great need for action in this area.

Image: First aid training with a dummy; Copyright: panthermedia.net/Mihajlo Maricic

A hospital can prepare itself for emergencies by regularly training a ward's staff; © Mihajlo Maricic

How can hospitals implement effective emergency management?

Koch: When it comes to implementing METs, the University Hospitals of Bonn and Dresden play a pioneering role in Germany. That’s why they serve as great practical examples.

Nursing staff, in particular, needs to be made aware of the defined early warning criteria and to act correctly in case of an emergency. Each year, we train approximately 2,000 associates. This means every hospital ward in our simulation center completes emergency training once a year. The staff trains emergency care and resuscitation procedures in a team. There are clearly defined algorithms and guidelines that need to be practiced, so they can be correctly applied in emergency cases. These algorithms and symptoms suggest a worsening of the patient’s condition and should be presented as a poster for instance in a perfectly visible way for the staff at the hospital wards.

In addition, hospitals need to provide uniform material at the hospital wards for use in an emergency for the staff to be able to quickly manage the situation. Automated defibrillators and first aid kits need to be promptly available on-site to avoid loss of time. By the way, a great tool to review your own emergency management preparedness and compare it with other hospitals is the German Resuscitation Registry by the DGAI (www.reanimationsregister.de, German website).

It is essential to include hospital management since training courses for the staff and emergency equipment require resources of course. Having said that, the use of these resources pays off because great emergency management improves patient safety and treatment quality and ultimately results in cost reductions for the hospital.

Image: Man with glasses and beard - Timo Roth; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.
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