“Code Help serves as a resource for patients as well as their families 24/7 in the event that they feel additional help is needed,” he says.
Schwartzberg says as GBMC continues to focus on ways to improve patient safety, “implementing Code Help is an integral component of our mission to provide medical care and service of the highest quality to each patient. Offering the Code Help program is a way to support that mission.”
Four months after UPMC implemented its Condition H program, St. Joseph Medical Center (SJMC) in Towson, Md., did likewise.
“During the past three months, our mortality (rate) is lower than it had been,” says Richard Boehler, MD, vice president of medical affairs and chief medical officer for SJMC. He spearheaded the RRT initiative. “Three months isn’t a trend or a pattern yet, but there aren’t that many things in my career that I have seen have such a profound impact. We’ve had a nice curve in terms of declining mortality.”
Dr. Boehler says the launch of an RRT at SJMC, comprising a critical care physician, an intensive care nurse, and a respiratory therapist, “is helping to prevent codes and mortality by intervening at the patient bedside or anywhere in the hospital where a patient’s condition is declining.”
Johns Hopkins Hospital (JHH) in Baltimore, Md., was planning to test a patient-activated system in its neuroscience unit this past fall but ran into a snag, according to Brad Winters, MD, assistant professor of anesthesiology and critical medicine at JHH.
“It got political when it was first proposed,” says Dr. Winters. “Some people had issues with it that had to be ironed out. It was modeled after (UPMC’s) program from which we created a brochure describing it in detail. But some of the feedback we got was negative.”
After much discussion and some revisions, “we ironed out the issues, and everyone is now on board with what we ended up with,” says Dr. Winters. “When the brochures come back from the printers now, they will tell families how the program works, why we have it, and how to use it. We intend to implement it not only in our neuroscience unit, but pediatrics.”
Dr. Winters says to a large degree the decision to implement the patient-activated RRT program “came from our attending conferences over the past couple of years. We considered the topic an important issue as we discussed it from a patient-care point of view.”
As far as he’s concerned, Dr. Winters says all hospitals “should consider such a policy since the families and loved ones of patients recognize subtle changes in the patient’s condition, while nurses, especially in pediatrics where moms and dads recognize those subtle changes quickly, may not.”
He says one of the initial concerns was that the program might be abused. “My take on it is that UPMC had it for a while and it was successful,” he says. “Nurses are very good, of course. But once in awhile the family picks up on something they miss, so it’s best to have as many eyes as possible involved. The more people we have observing a patient, the more likely that patient is to get good care.”
Back at UPMC, Martin says they’ve had no complaints about the program and Condition H is “spreading to every acute care hospital.” In the first nine months of 2005, Condition H was used 21 times “successfully,” she says. That’s about average use annually, she says.
But some hospitalists remain skeptical.
“In my opinion, having a patient or family call a code is the medical equivalent of having a patient tell the surgeon where to make an incision,” says Dr. Michael Rudolph, MD, a hospitalist for the past three years at Milford Hospital in Milford, Conn. “This ‘solution’ practiced [by UPMC] demonstrates a complete failure in communication between all the hospital staff and physicians and the patient and family.”