Thursday, August 17, 2006
Hospital care better with rapid response teams

By Dr. Anthony Policastro
Nanticoke Memorial Hospital
Medical Director

Most patients in hospitals are monitored very closely. The monitoring includes things like blood pressure. It includes things like heart rates. It includes breathing rates. It includes things like checking oxygen levels. When patients begin to have problems, these kinds of things show changes. Unfortunately, many times the changes are not that obvious. There may be a slight drop in blood pressure. It may then become a bigger drop later. The question is at what point do you need to take action. There is not always a clear-cut answer. Nurses gather this kind of information. They then have to decide when to call the physician. There is no need to call for a false alarm. However, it is not prudent to wait until it is clear that there are problems. It is a difficult position to be in. The physician has to evaluate the information. Based upon that evaluation, action might be taken. The problem is that the physician is often making decisions without seeing the patient first hand. He/she may be in the office in the midst of a busy day. He/she may be out shopping. He/she may be home in bed. A decision needs to be made. The decision might be to continue observing the patient for further changes. The decision might be ordering some lab tests or X-rays. The decision might be ordering some medication. The decision might be coming to see the patient. These kinds of decisions are not always clear. A new trend has arisen in the way we provide medical care. The trend is to use what are called rapid response teams. A rapid response team is a group of individuals who are already in the hospital. They are experts in handling seriously ill patients. They can quickly come to evaluate a patient. It allows the nurse who is not sure about changes to have an additional set of evaluators. It allows the physician who is not in the hospital to hear more information about the patient. The result is an earlier evaluation of a patient than might have otherwise occurred. There are different types of individuals who can be on a rapid response team. The team may include a physician who is in the hospital. The presence of hospitalist physicians in many hospitals results in a physician presence that was not possible before. Critical care nurses might also be involved in responding. Since most problems are respiratory problems, a respiratory therapist might also be on the team. Hospitals that have used this system have found that patients indeed were evaluated quickly. They found that patients were evaluated earlier than would have been the case. Most importantly, they found that a significant number of patients were checked so early that they did not go on to get worse at all. Rapid response teams have proven their value. Patients will see more and more of them in the future. They will address a variety of patient problems very early. The result will be that less patients will go on to have worsening of those problems.

The 100,000 Lives Campaign
By Dr. Rob Ferber

Everyone knows that medical care is very complicated, and that the more complicated something is, the more chances there are of making mistakes. We are bombarded with media messages telling us to be very careful in our medical care. They tell us to become educated consumers, in order to protect ourselves. The articles we see about this can be pretty scary, and yet, how much can we as individuals do? A few years ago, the Institute of Medicine completed a study that said that about 98,000 people die in U.S. hospitals every year due to medical injuries. This shocking number caused many experts to really examine this issue closely.

These experts realized that in most cases, it is not simply human error at fault. The experts said that human errors are unavoidable, and so the best thing to do was to design systems that prevent those errors from harming patients. An example of this kind of thinking comes from the airline industry. A pilot preparing for take-off must go through a safety checklist that makes sure that each key system of the plane is ready for take-off. This way the pilot does not forget any important steps. On a commercial plane, all of the flight crew participate in making sure that all of the parts of the checklist are just right, which helps to make sure that no-one skips a step. Everyone has probably heard of the stories in which a surgeon has removed the wrong leg from a person who needed an amputation. That kind of error can be prevented by the same kind of routine checklist. As a result of those terrible mistakes, all surgeons must go through a checklist to be sure that everything is just right before beginning any operation or medical procedure. The entire operating team of doctors and nurses, just like the flight crew, are responsible to be sure the checklist is done right. This simple step should prevent that kind of error from ever occurring again. People in the health care system are trying hard to find ways to improve things in order to make health care safer and more effective. One non-profit organization, the Institute for Healthcare Improvement, began an effort called the "100,000 Lives Campaign." The goal of this campaign was to save 100,000 lives over an 18-month period, which ended in June of 2006. Over 2,000 hospitals across the country signed up as volunteers in this campaign. The hospitals included some of the largest and most famous to small, community hospitals, including Nanticoke Memorial Hospital. There were six changes recommended for the hospitals to consider. Some of the changes were simple, and others much more complicated, and so each hospital had to develop its own way to make these changes, with lots of advice and support from the campaign. In June, the studies have shown that about 125,000 lives have been saved thanks to these efforts! To give an example close to home, one of the six recommendations was "Prevent Ventilator Associated Pneumonia." This kind of pneumonia can occur when a person is on a ventilator ("breathing machine"). This pneumonia is very serious and may result in death. In order to bring the best science into action, a group of doctors, nurses, and respiratory therapists at Nanticoke Hospital developed a series of "Doctors Orders" which ensured that every patient on a ventilator always received a number of different therapies to help prevent this complication. Some of the steps were very simple, such as raising the head of the bed at all times, and others involved using medications in certain ways. The result at Nanticoke has been that not one single patient has developed this complication since the new Doctors Orders were started. This kind of success story has been repeated in hospitals throughout the country, with many, many lives saved as a result. In upcoming articles, we will look at some of the other efforts that are part of this exciting campaign.

Nearly 1,000 expected to participate in Delaware Alzheimer's Memory Walk Day
Nearly 1,000 walkers are expected to participate in the Alzheimer's Association Delaware Valley Chapter's Memory Walk Day 2006 on Saturday, Sept. 30, at two locations in Delaware. Memory Walks will take place simultaneously at the Wilmington Riverfront in Wilmington and Grove Park in Rehoboth Beach. The Wilmington walk will be chaired by Bill Denzer of MetLife and John Cox of Commerce Bank, while the Rehoboth walk will be chaired by Tawyna Dennis of LifeCare at Loftland Park. The Delaware walks are two of five walks organized by the Delaware Valley Chapter in the tri-state area of Southeastern Pennsylvania, South Jersey and Delaware. The other walks will take place in Pennsylvania – Sunday, Oct. 8, Memorial Hall in Fairmount Park, Philadelphia, and Saturday, Oct. 14, Kutztown University (Berks County, Lehigh Valley); and South Jersey – Sunday, Oct. 15, The Board walk Garden Pier at New Jersey Avenue, Atlantic City. In Rehoboth, for the second year in a row, two-person band Imagine will be performing. Refreshments will be available. There is no registration fee to participate in the walks, but participants are urged to raise a minimum of $100 and receive a gift of a T-shirt. Other incentives include a lunch box cooler, tote, umbrella, event blanket, and wheeled backpack. As an added incentive, the top 100 walkers in the state of Delaware will be invited to a complimentary luncheon at Outback Steakhouse in Newark. All funds raised through Memory Walk will go directly to support the free programs and services provided by the Delaware Valley Chapter. To register for Memory Walk, visit the chapter's website at or call toll free at 1-866-224-5224. For more information on Memory Walk in Delaware, call Marissa Prulello, special events coordinator, at 302-633-4420 or e-mail The Delaware Valley Chapter, which serves Delaware, South Jersey and Southeastern Pennsylvania, includes the counties of Berks, Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton and Philadelphia in Southeastern Pennsylvania; Camden, Burlington, Gloucester, Salem, Cumberland, Atlantic and Cape May in South Jersey; and Kent, New Castle and Sussex in Delaware. The tri-state headquarters is located at 100 North 17th St., 2nd floor, in Philadelphia. Its phone number is 215-561-2919, with their website at The local office is in Georgetown (854-9788). The Alzheimer's Association Delaware Valley Chapter provides a wide range of services to 294,000 individuals suffering from Alzheimer's disease and related disorders and their families including family caregiver training, a 24/7/365 toll-free Contact Center/Helpline (1-800-272-3900), support groups and multicultural outreach.