Wireless Cardiac Event Alert Monitoring is Feasible and Effective in the Emergency Department and Adjacent Waiting Areas

From Critical Pathways in Cardiology:

Abstract:

The need for vigilance for unexpected clinical deterioration in the emergency department (ED) waiting area and in unmonitored treatment areas of the ED continues to increase. We sought to determine in an observational study the feasibility and relative false-alarm burden of, and satisfaction with, a novel wireless automated clinician alert device for cardiac rate and rhythm derangements in a teaching hospital ED.

Patients presenting with a variety of complaints who after ED triage were not placed on conventional telemetric monitoring (by standard triage policy) were considered for inclusion. Those enrolled in the study were then monitored in the waiting room and in the ED proper via a wireless, one-lead ECG device that, through relay hubs installed in the ED ceiling, alerted clinicians via desktop computers at regular ED work stations to the presence of asystole, ventricular fibrillation, and bradycardia and tachycardia in those patients. The device is not a conventional telemetry monitor, in that it does not provide streaming visual monitoring capability; instead, it provides alarms and one-lead ECG data when triggered by specific rate and rhythm deviations.

A total of 298 ED patients (30.2% patients triaged after a run-in period) were monitored, for a mean duration of 3.53 hours. Productive clinical alarms (those that prompted a change in patient therapy, location, or intensity of monitoring) occurred in 20 patients (6.7%); the most common response to an alert was earlier transition from the waiting room into a clinical space in the ED. There were 10 false-positive asystole or ventricular fibrillation alarms in 4 patients (1.3%), all of which were readily attributable to nonclinical origins, such as poor lead adherence. There was excellent satisfaction with the device from both patients and clinical personnel.

Wireless cardiac event monitoring is feasible in the ED, and improves the throughput of ED patients with worsening vital signs, and may improve overall patient safety, without an onerous burden of nonproductive alarms.

Wisconsin hospitals move toward wristband standardization

From Modern Healthcare:

Nearly 80% of hospitals in the state of Wisconsin have standardized the use of color-coded wristbands, falling short of the Wisconsin Hospital Association’s goal of 100% standardization by March 1.

Despite not meeting that goal, the association said the high number of hospitals that are now using the same colors on wristbands to identify different medical conditions means they recognize the need to standardize to improve patient safety. “We are aware of more hospitals that will have this process in place very soon,” Dana Richardson, vice president of quality initiatives for the association said in a news release.

Number Needed to Treat

From the Student Doctor Network:

Just heard an interesting speaker Dr David Newman – Research EM Columbia U. Here are some of the numbers he cited in his lecture today regarding numbers needed to treat. Or in other words, how many patients I have to treat with (SAID) therapy in order to save a life or whatever intended goal you might have.

Rapid defib of V-fib NNT 3
Hypothermia for cardiac arrest NNT 6
Sepsis Early Goal Directed Tx NNT 6
BIPAP for COPD NNT 10
Low Tidal Volumes/ARDS NNT 12
ASA for MI NNT 40
PCI NNT 30-40
ASA (post MI) prevention NNT 100
Statin (known CAD) prevention NNT 400
Statin (No CAD) prevention NNT 5000
Seat belt for MVA NNT 25,000

BBlocker for STEMI NNT – Infiniti
Mammograms – death prevent NNT – Infiniti
GIIbIIIa for STEMI NNT – Infiniti
GIIbIIIa for NSTEMI NNT – 250 (only a 30day benefit)

ABX for COPD (preventing bounce back) NNT – 3
Prednisone for Asthma (as above) NNT – 10
ABX for COPD (as above) NNT – 12

CT Scans in Trauma Patients Reveal More Incidental Findings

From MedPage Today:

Physicians are finding an increasing number of previously unrecognized injuries and conditions when they conduct cervical spine CT scans on their patients, researchers here said.

In nearly fifth of trauma patients who underwent a CT scan of the cervical spine during an initial trauma evaluation, there were incidental findings, including fractures of the ribs and skull, as well as osteopenia, osteoporosis and emphysema, Shella Farooki, M.D., of Grant Medical Center, and colleagues reported in the March issue of the American Journal of Roentgenology.

“A lot of patients come into the ER as trauma patients, but are leaving with diagnoses that are not related to trauma,” Dr. Farooki said.