Consultations and Added
Monitoring
A total of 181 (97.3%) of 186 patients
received at least 1 consultation from a
variety of providers, including physicians,
nurses, and respiratory therapists.
For first consultations, 159
(87.8%) included a medical doctor. The
median time from the first consultation
before the event was 80 minutes.
As shown in Table 2, 98% of study
patients had pulse oximetry monitorTing initiated before the RRT or code
blue event. This is used instead of cardiac
monitoring for patients who are
outside the ICU, and nurses can
independently initiate it. A total of
81 (43.5%) patients had monitoring
added during the 24-hour pre-event period.
The median time of the first addition
of a monitor before the event was
6 hours, 54 minutes. This additional
monitoring was interpreted as evidence
of some staff awareness of
change in patient condition. Evidence
of documented increased frequency of
nursing assessment was rare at 7%.
We evaluated a subgroup of 72 patients
who shared 3 common findings:
(1) critical PEWS; (2) clinician consultation;
and (3) addition of a monitor.
When all median times to the event
were compared, they were signifi-
cantly different (P .001). The median
time to first consultation was 73 minutes,
which was significantly less than
first critical PEWS at 602 minutes (10
hours, 2 minutes; P .001). The median
time for addition of a monitor was
406 minutes (6 hours, 46 minut