Royal Victoria Hospital’s SWAT team swoops in

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Lisa Paul was scared.

She was extremely panic stricken. She thought she was going to die. Although in a blur of confusion and pain, she never let her eyes leave the face of Royal Victoria Hospital (RVH) critical care unit nurse Beth Hickey. “I remember saying to Beth, ‘Please don’t leave me. I need someone right beside me.’ She didn’t leave me. Beth stood right beside me, calmed me down and helped me keep breathing,” recalls Paul. “I truly believe that Beth, and the other members of the team, saved my life.”

Interestingly, Lisa was not in the critical care unit (CCU) but rather on 4NC after having surgery. The team Lisa is referring to is the Critical Care Outreach Team (CCOT), newly created at RVH. Comprised of an intensivist, respiratory therapist and an ICU trained RN, this team is on alert 24-hours-a-day, seven-days-a-week. The team members wear pagers, and if a nurse on any floor in the hospital believes their patient’s health is deteriorating and further assistance from them is out of their scope of practice, they page the CCOT.

That’s when team members like Sharon Forster can’t wait for that pager to go off. When it does, Forster immediately triages the call to assess how quickly she needs to assemble the team and then heads to the floor. If, as in the case of Lisa Paul, the CCOT is needed immediately, she calls the intensivist, respiratory therapist, grabs the team’s life-saving portable medical station and heads to the patient’s bedside, where the rest of her team will be gathering.

Quite often Dr. Doug Austgarden, an intensivist at RVH, is right on her tail. He likens the way in which the team assembles to that of a SWAT Team. “This program is designed to bring the technology of an Intensive Care Unit, and the skills of the professionals who work there, to the bedside of a patient who is experiencing a deterioration in their clinical status,” explains Dr. Austgarden. “Research shows that if we treat these patients early they won’t get as sick, in 80 per cent of cases it prevents ICU/CCU admissions. Ultimately, our presence saves lives.”

There are currently 27 Ontario hospitals with similar teams. RVH’s CCOT was formed in September 2007 and went 24/7 in December 2007. This is a three-year pilot project funded by the Ministry of Health and Long Term Care as part of the Critical Care Strategy for the province. The program, which originated in Australia, is called the Critical Care Response Team, but the RVH team changed its title to reflect what is actually happening on the floors when they respond to a call. “We named ourselves the Critical Care Outreach Team because we are reaching out, not only to the patient in distress, but to the nurses on the floor as well. A huge benefit to this program is that we provide the ward nurses with peer group support,” says Dr. Austgarden.

Forster couldn’t agree more. “When the nurses on the floor page us we respond just like paramedics to a 911 call,” says Forster, who says the team has responded to more than 100 calls since December. “I love it because it gives me a chance to go outside the CCU and work with patients and floor nurses that I don’t often get a chance to see. It is a great opportunity to challenge your own skills, however, our primary goal is patient safety.”

In Paul’s case she had just undergone an operation to remove her thyroid, and was recovering on 4NC. Everything seemed to be going well and she was getting ready to be discharged when her hands began to tighten up and go into a claw-like posture. Eventually, her lips felt the same way, her tongue felt swollen and her hands were beginning to hurt. “I didn’t know what it was, but I was panicking because I was losing my ability to speak. I remember screaming, ‘I can’t feel my tongue.’ My dad had a stroke and I thought that’s what was happening. I could hear the woman in the next bed praying for me,” says Paul. “The pain in my hands was so severe by this time, I can’t even describe it.”

Nurses on the floor called for CCOT. Paul believes they were at her bedside within minutes, were able to calm her down, assess her condition, give a medical directive and within two hours of onset, Paul was feeling more herself.

She had experienced a severe calcium deficiency related to the thyroid surgery. It is something only one to two per cent of patients, who undergo the same surgery, will experience. “I think the Critical Care Outreach Team is awesome. They were right there almost immediately after the nurses called them. They stayed with me and listened to me. I really feel as if they saved my life.”