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Introduction of an OBstetric Emergency Team (OBET) Response System: Response Dose as a Metric of Successful Implementation
Abstract Number: T 20
Abstract Type: Original Research
Background: The goal of rapid response teams (RRTs) is to rapidly recruit life-saving skilled personnel in time to “rescue” patients showing early signs of a trajectory towards cardio-respiratory arrest. Principles underpinning effective RRTs include low threshold for activation and no negative consequences for activators.1 This encourages front-line providers to activate RRS confidently whenever they first suspect patient peril.
Life-threatening problems experienced by parturients are not uncommon and are unique compared to the general hospital population. Timely intervention is often effective. Our unit (4,600 deliv/y)introduced an obstetric emergency team (OBET) system in April 2010, a variant of RRT, designed to activate team responses to obstetric emergencies.1,2 Unlike hospital RRTs, our OBET members consist of the large group of inter-professional personnel who routine collaborate in caring for parturients (obstetrics, nursing, anesthesiology, neonatology, OR technicians). OBET is activated by a single call, and all team members receive an audible alert on their service mobile phones. This study examined the OBET utilization rate using a standard metric for RRT utilization.
Methods: IRB approval was obtained. Monthly OBET usage was obtained from the Dept of Obstetrics quality database. Quarterly OBET “response dose” was calculated, and then adjusted per 1,000 deliveries: 1,000 x [# OBET activations during quarter]/[total deliveries during quarter].
Results: Actual and adjusted OBET response doses are presented [see figure]. The increase was linear from initial months of implementation to present. Quarterly OBET response dosee has risen to 65-75 per 1,000 deliveries. This represents an average of nearly one OBET call per day on our unit with 4,600 deliveries per year.
Discussion: A RRT response dose of 25/1,000 admissions represents success for hospital RRTs, while >40/1,000 admissions reflects a “mature academic system”.3 Adverse outcomes have been reported to be inversely related to increasing response dose. 3 The dose representing success for an OBET system is unknown. Our response dose far exceeds that reported for the only two other published OBET systems.1,2 Several unique attributes (cultural, technological, team composition, monitoring/improvement) likely account for this liberal utilization.
Ref: 1) Grosman G. Am J Obstet Gynecol 2008;198:367.e1-7. ) Clements C. Nurs Womens Health 2007;11:194-9. 3) Jones D. New Engl J Med 2011;365:139-46.