Patient instability and adverse patient outcomes are a continued concern since the IOM sentinel report that 98,000 hospitalized patients died each year due to complications.1 Hospitalized patients requiring diagnostic procedures in the Radiology Department (RD) range from """"""""stable"""""""" patients admitted for elective surgery to highly unstable critically-ill patients who require a high level of technologic monitoring and physiologic support, including mechanical ventilation and hemodynamic assistance. The safety of the vulnerable population of hospitalized patients while being treated in the RD and Failure-to-rescue (FTR) of in- patients who become unstable in the RD is not well understood. The purpose of this proposed pilot study is to describe the incidence of Medical Emergency Team (MET) rescue events of unstable in-patients while in the RD of a tertiary care hospital.
The specific aims of this study are to: 1. Describe the characteristics of in- patients who experience a MET activation while in the RD in regard to their: a. Non-modifiable patient characteristics, b. Modifiable patient characteristics and c. Modifiable surveillance characteristics;2. Determine if there are differences in the characteristic profiles of patients who have a poor outcome post RD-MET (higher level of care post MET, FTR [do not survive to discharge]), and those whose outcome is good (return to same level of care post MET, survive to discharge);and 3. Compare the incidence of MET activations for in-patients in the RD to the incidence of MET activations occurring on the general in-patient units of the same facility for the same time period. Since there is little known regarding the cardiorespiratory compromise experienced by patients while they are away from the in-patient units for test and procedures, this pilot study utilizes a descriptive comparative survey design to better describe the characteristics of patients who become unstable during radiologic procedures, and determine patient characteristic influences on poor outcomes. The information gained will provide the pilot work to further investigate the in-patient population most at-risk for instability and to develop interventions that will improve patient outcomes, including but not limited to education and practice improvement. A training plan has been established to accomplish this proposed study, establish a research trajectory in patient instability, and develop skills as an independent researcher. In addition to the required course work for completion of the PhD program, the training plan includes further study in epidemiology;advanced data analysis, and translation of research to practice and FTR by means of independent study and mentorship with experts in patient instability and FTR.

Public Health Relevance

FTR is of vital concern in today's healthcare environment, and impacts not only patient safety and improved outcomes, but hospital economics and medical litigation. Improving the ability of nurses to identify patients at greatest risk for instability and poor outcomes in the RD will have a positive impact on public health by influencing policies of patient/nurse staffing, scheduling of RD admissions, and patient surveillance. We anticipate that information gained in this study and continuation of the candidate's research trajectory will result in decreased patient instability in the RD through the development of measure to proactively identify the patient at risk, improved patient surveillance, and earlier instability detection and intervention, ultimately benefiting overall public health by improving the safety of at-risk patients while in the RD.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of Pittsburgh
Other Health Professions
Schools of Nursing
United States
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Ott, Lora K; Pinsky, Michael R; Hoffman, Leslie A et al. (2015) Patients in the radiology department may be at increased risk of developing critical instability. J Radiol Nurs 34:29-34
Ott, Lora K; Pinsky, Michael R; Hoffman, Leslie A et al. (2012) Medical emergency team calls in the radiology department: patient characteristics and outcomes. BMJ Qual Saf 21:509-18
Ott, Lora K; Hoffman, Leslie A; Hravnak, Marilyn (2011) Intrahospital Transport to the Radiology Department: Risk for Adverse Events, Nursing Surveillance, Utilization of a MET and Practice Implications. J Radiol Nurs 30:49-52