High value healthcare analysis of “triggers” in deteriorating patients

Abstract

Objective: To review “triggers” for deteriorating patients who required intervention by a medical emergency response team (MET). In addition, to assess whether these “triggers” differed by medical or surgical governance of these patients. A secondary objective was to report laboratory investigations performed via the MET, with particular interest in tests duplicating haemoglobin (Hb) values and their degree of concordance within the context of low-cost, high value inpatient care.
Methods: This quality improvement initiative involved a prospective observational cohort of inpatients, who were attended to by the MET at Royal Perth Hospital in Perth, Western Australia over a 2-year period between 2020 and 2022.
Results: The mean number of MET calls for inpatients under surgical governance was slightly higher than for those patients under medical governance (1.34 vs. 1.25 calls respectively p = .03). Hypotension triggered a MET call in 184 (40.9%) surgical patients compared to 154 (28%) under medical governance (p < .001). Comparing haemoglobin values obtained from FBP and VBG, Lin’s concordance correlation coefficient (CCC) was found to be 0.986, 95%CI: 0.983, 0.989. The Bland-Altman limits of agreement suggest that the haemoglobin value on a VBG ranges from 9.55 g/L higher than the FBP to 4.7 g/L lower than the FBP.
Conclusions: Significant differences in the frequency of triggers for patients under medical vs surgical governance highlight the need for proactive planning around hypotension management of patients under surgical governance. In addition, understanding the nuances between haemoglobin values obtained from FBP and VBG can help with value-based health care and efficiencies in patient care, since measuring haemoglobin values is one of the key components in hypotension management.