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Rapid Response Checklists- A Pilot Study for a Novel Approach
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A6837 - Rapid Response Checklists- A Pilot Study for a Novel Approach
Author Block: P. Thacker, A. Rafiq, D. Schneider; Internal Medicine, Abington Jefferson Health, Abington, PA, United States.
Purujit J. Thacker1, Ali Rafiq1, Doron Schneider1
1.
Abington- Jefferson Health, Abington, PA, USA.
Rationale: The goal of rapid response teams is to intervene early on in deteriorating non-intensive care unit patients to decrease morbidity and mortality. While rapid response teams are widely prevalent, standardization of their approach has not been studied well. Our goal was to assess residents' ability to think of adequate differential diagnoses in a high-pressure scenario.
Methods: 18 Internal Medicine residents from the same residency program were given clinical vignettes and asked to list differential diagnoses for three hypothetical scenarios - acute hypoxia, acute change in mental status, and cardiopulmonary arrest. Their answers were compared to a standardized list of life-threatening differential diagnoses. Participants were also surveyed to see if they thought such checklists would be useful during rapid responses
Results: Residents listed 16 different differential diagnoses for acute hypoxia. Most residents listed pulmonary embolism (PE) (94.4%), CHF exacerbation (89%), and COPD (67%) as one of the differential diagnoses of acute hypoxia. Only 50% residents listed pneumonia as a possible cause. Aspiration pneumonitis (33.3%) and pneumothorax (27.7%) were listed by fewer than half the residents; none thought of airway obstruction. A total of 16 different differential diagnoses were listed for an acute change in mental status, with intracranial hemorrhage (89%) and ischemic stroke (55.5%) being the only two listed by more than half the residents. Seizure (33%), hypoglycemia (27.8%), and adverse drug reaction (33%) were recognized by less than half the residents, while none CNS infection as a possible cause. A total of 19 different possibilities were listed as causes of cardiopulmonary arrest, with acute coronary syndrome (72.2%), PE (66.7%), and electrolyte abnormalities (50%) being the most common ones. Hypoxia (44.4%), acidosis (38.9%), cardiac tamponade (38.9%), toxins (27.8%), and hypothermia (16.7%) were included by less than half the residents. None thought of tension pneumothorax. In the secondary survey, 87.5% residents expressed that a checklist of differential diagnoses and clinical tests would be a useful addition to the rapid response team
Conclusion: Findings from this pilot study indicate variability in the approach of residents towards common rapid response scenarios. Several critical diagnoses were missed even in a controlled testing environment. The use of checklists during rapid responses may lead to fewer missed or delayed diagnoses, thereby increasing patient safety. This study also suggests that residents would welcome such a measure. More research in this area is required.
Author Block: P. Thacker, A. Rafiq, D. Schneider; Internal Medicine, Abington Jefferson Health, Abington, PA, United States.
Purujit J. Thacker1, Ali Rafiq1, Doron Schneider1
1.
Abington- Jefferson Health, Abington, PA, USA.
Rationale: The goal of rapid response teams is to intervene early on in deteriorating non-intensive care unit patients to decrease morbidity and mortality. While rapid response teams are widely prevalent, standardization of their approach has not been studied well. Our goal was to assess residents' ability to think of adequate differential diagnoses in a high-pressure scenario.
Methods: 18 Internal Medicine residents from the same residency program were given clinical vignettes and asked to list differential diagnoses for three hypothetical scenarios - acute hypoxia, acute change in mental status, and cardiopulmonary arrest. Their answers were compared to a standardized list of life-threatening differential diagnoses. Participants were also surveyed to see if they thought such checklists would be useful during rapid responses
Results: Residents listed 16 different differential diagnoses for acute hypoxia. Most residents listed pulmonary embolism (PE) (94.4%), CHF exacerbation (89%), and COPD (67%) as one of the differential diagnoses of acute hypoxia. Only 50% residents listed pneumonia as a possible cause. Aspiration pneumonitis (33.3%) and pneumothorax (27.7%) were listed by fewer than half the residents; none thought of airway obstruction. A total of 16 different differential diagnoses were listed for an acute change in mental status, with intracranial hemorrhage (89%) and ischemic stroke (55.5%) being the only two listed by more than half the residents. Seizure (33%), hypoglycemia (27.8%), and adverse drug reaction (33%) were recognized by less than half the residents, while none CNS infection as a possible cause. A total of 19 different possibilities were listed as causes of cardiopulmonary arrest, with acute coronary syndrome (72.2%), PE (66.7%), and electrolyte abnormalities (50%) being the most common ones. Hypoxia (44.4%), acidosis (38.9%), cardiac tamponade (38.9%), toxins (27.8%), and hypothermia (16.7%) were included by less than half the residents. None thought of tension pneumothorax. In the secondary survey, 87.5% residents expressed that a checklist of differential diagnoses and clinical tests would be a useful addition to the rapid response team
Conclusion: Findings from this pilot study indicate variability in the approach of residents towards common rapid response scenarios. Several critical diagnoses were missed even in a controlled testing environment. The use of checklists during rapid responses may lead to fewer missed or delayed diagnoses, thereby increasing patient safety. This study also suggests that residents would welcome such a measure. More research in this area is required.
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