Condition C Program
They are virtual mobile intensive care units capable of responding within 90 seconds to any area of the hospital with the right expertise and the right equipment to save lives.
With a single telephone call, physicians and staff members on a growing number of UPMC hospital campuses can initiate a "Condition C" (crisis intervention) and summon a medical emergency team (MET) to the scene of a patient crisis.
The Condition C Program stresses that every staff member should pick up a phone and call a Condition C when a patient is in crisis. Data have shown that when the number of Condition C responses increases, the number of Condition A (cardiopulmonary arrest) responses decreases. In short, Condition C can and does save lives.
Medical research has demonstrated that more than one-half of in-hospital cardiopulmonary arrests are preceded by a period of clinical deterioration lasting several hours.
METs are distinct from other “code” response teams because their goal is to respond to acute patient deterioration before a cardiopulmonary arrest occurs. When staff recognize the crisis and call a Condition C, the MET can intervene and prevent the arrest from ever occurring.
When staff call for Condition C, hospital operators answer each call on the first ring. The operator records the location and type of condition, simultaneously activates all the MET member pagers, and announces the type of condition and location twice on overhead loudspeakers. The MET and equipment designated for that area respond.
Shaping a Great Idea to Fit Needs at All UPMC Facilities
The merits of the Condition C Program have been shared with clinicians throughout the University of Pittsburgh Medical Center. One of its community hospitals, UPMC McKeesport, has taken the Condition C Program and shaped it to fit its needs.
UPMC McKeesport took the MET concept and decided to treat every event — whether it’s a patient crisis or a cardiopulmonary arrest — with the same level of prioritization. This approach works better at UPMC McKeesport based on its staffing resources and other factors.
Enlisting Support From All Staff
Clearly defined procedures and reliable communications are crucial to establishing a successful crisis response program. However,other issues also had to be addressed as the MET system moved forward.
For example, one potential barrier was the mistaken perception that staff might be reprimanded if they called in an unwarranted Condition C. To tackle this issue, UPMC Presbyterian’s Patient Safety Committee identified objective patient criteria for calling a Condition C response.
These criteria were printed on laminated cards and distributed to staff. The cards list specific heart rates, blood pressure rates, neurologic changes, and other medical criteria that, based on objective physiologic parameters, indicate a patient crisis and warrant a Condition C response. This approach prevents variable interpretation of what is a crisis.
In December 2000, the objective criteria were widely distributed throughout the hospital. In-service presentations, conferences, and other events were held to explain the criteria. In addition, the criteria were posted on every nursing unit and sent to every faculty and trainee physician. The initiative had a successful impact. A year later, the number of requests for Condition C responses rose while incidences of fatal cardiopulmonary arrest decreased.
Striving for Additional Improvements
Efforts are under way to further enhance the effectiveness of the METs. Mock codes are held regularly. Such practice responses are especially important in a large hospital such as UPMC Presbyterian.
Patient units frequently move to other locations in the hospital, making it critical that all staff, from the clinicians on the METs to the operators announcing the Condition C, know the correct name and location for each unit.
MET training is completed at the Peter M. Winter Institute for Simulation, Education, and Research (WISER), which uses full-size computerized human simulators to teach physicians and staff members how to complete their assigned roles in responding to Condition Cs. WISER is located on the UPMC campus in the Oakland section of Pittsburgh.
One focus of the training at WISER is to teach each health care professional on each eight-member MET his or her specific role when responding to a Condition C. Each team member is assigned a position around the patient in crisis and is responsible for two or three specific duties. For example, the airway manager stands behind the head of the patient and is responsible for oxygenation and ventilation. A nurse based in an intensive care unit prepares medications and the defibrillator. The procedure physician stands on the right side of the patient. The physician responsible for chest compressions stands in an assigned spot. A staff member from respiratory care handles oxygen supply, suction, and respiratory equipment. The team leader also has an assigned position to direct treatment and set priorities.
Contributing to Quality Improvement
The causes that lead to each Condition C response are reviewed by the Condition Review Subcommittee of the Patient Safety Committee. By auditing crisis responses, processes that may have contributed to them can be identified. At that point, those underlying processes can be modified to eliminate the occurrence of a similar patient crisis.
Through this process, UPMC has been able to identify ways to standardize practices, protocols, and equipment to further enhance patient safety.
The use of METs extends beyond ensuring effective responses to inpatient crises. It also can be used as a quality improvement tool to identify processes within UPMC institutions that need to be analyzed or reviewed.