Summary Objective To explore the reasons why nursing staff use the subjective “worried” Medical Emergency Team (MET) calling criterion and compare the outcomes of calls activated using the “worried” ...criterion with those calls activated using “objective” criteria such as vital sign abnormalities. Methods A descriptive study of MET calls in six acute hospitals over a 12 months period. Outcomes for “objective” and “worried” calls were compared. Results The “worried” criterion was used to activate 29% of 3194 MET calls studied; it was the single most common reason for a MET call. Half (51.7%) of the “worried” calls were related to problems with Airway, Breathing, Circulation or Neurology. ‘Breathing’ problems accounted for the largest proportion (35.2%). A low oxygen saturation by pulse oximetry (SpO2 ) ( n = 249, 26.9%) and ‘respiratory distress’ ( n = 133, 14.4%) were the most common reasons for a “worried” call. Only 1.1% (10) of calls triggered by the “worried” criteria had cardiac arrest as an outcome compared with 170 calls (7.6%) for “objective” criteria. The proportion of patients who remained in a general ward area after MET calls was higher for the “worried” calls. Conclusions The “worried” criterion was the most frequent reason for MET calls, implying a high degree of empowerment and independent action by nursing staff. Low SpO2 and respiratory distress were the most common causes for concern. There was a significant difference between MET calls triggered by “worried” criteria and “objective” criteria for outcomes immediately following MET ( p < 0.001). Further assessment and refinement of MET triggers particularly in relation to respiratory distress and pulse oximetry may be needed.
Family-centred critical care recognises the impact of a loved one's critical illness on his relatives. Open visiting is a strategy to improve family satisfaction and psychological outcomes by ...permitting unrestricted or less restricted access to visit their family member in the intensive care unit (ICU). However, increased family presence may result in increased workload and a risk of burnout for ICU staff.
The objective of this study was to evaluate ICU staff perceptions regarding visiting hours and family access in Australian and New Zealand ICUs. Secondary outcomes included an evaluation of current visiting policies, witnessed events in ICUs, and barriers to implementing open visiting policies.
A web-based survey open to all healthcare workers in Australia and New Zealand ICUs was distributed through local, state-based, and national critical care networks. Open visiting was defined as ICUs open for visiting >14 h per day.
We received 1255 valid responses. Most respondents were nurses (n = 930, 74.1%) with a median critical care experience of 10 y. Most worked in open visiting ICUs (n = 749, 59.7%). Reported visiting hours varied greatly with a median of 20 h per day (interquartile range: 10–24 h). Open visiting was perceived as beneficial for the relatives, but less so for patients and staff (relatives: n = 845, 67.3%, patients: n = 561, 44.7%, staff: n = 257, 20.5%, p < 0.0001). Respondents from closed visiting units and nurses identified more risks from open visiting than other professional groups. Generally, staff preferred not to change from their current practice.
We report that staff perceived open visiting as beneficial for relatives, but also identified risks to themselves, including increased workload, a risk of burnout, and a risk of occupational violence. Reluctance to change highlights the importance of addressing staff perceptions when implementing an open visiting policy.
