He found that patients transferred to the ICU more than four hours vs. less than four hours after suffering a physiologic deterioration were 55% less likely to receive major medical interventions in the first six hours. "Timely medical interventions appear more likely to happen in patients transferred rapidly to the ICU compared with 'slow transfer' patients.
Our early data suggests that many interventions, such as mechanical ventilation and very large amounts of intravenous fluid administration (often needed in cases of severe infection) may be deferred until after patients are transferred to the ICU from the ward," Dr. Young said.
In the study he conducted in Utah, Dr. Young found that when a patient's nurse notified a physician about the patient's change in vital signs within two hours of the event, the patient was far more likely to be transferred to the ICU in less than four hours ('fast patients'). "In that study, the differences in death rates were huge--41% of 'slow transfer' patients died, compared with just 11% of 'fast transfer' patients," Dr. Young noted. "In our Utah study, a barrier to timely evaluation of patients appeared to be a communication gap between nurses and doctors. This gap likely delayed doctors coming to the bedside to re-evaluate patients."
Other related questions need further study, Dr. Young noted, such as, "Do treatments and outcomes differ for hospitalized patients who becomes sicker at night and on weekends versus during the day Monday through Friday? What is optimal frequency of vital signs? And does the nurse-to-patient ratio influence a nurse's decision to contact a physician wh
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Contact: Jim Augustine, Bill Glitz or Cathy Carlomagno
medsci@earthlink.net
407-685-4098
American Thoracic Society
24-May-2004