ABSTRACT
OBJECTIVE: Medical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine whether NP-led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR)-led MET calls. METHODS: The composite primary outcome included recurrence of MET call, occurrence of code blue or ICU admission within 24 h. Secondary outcomes were mortality within 24 h of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group. RESULTS: A total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR-led MET calls (26.7% vs. 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 h (3.4% vs. 7.7%, p = 0.002) and hospital mortality (12.7% vs. 20.5%, p = 0.001) were higher in ICUR-led MET calls. Propensity score-matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups, but NP-led group was associated with reduced risk of hospital mortality (OR 0.57, 95% CI 0.35-0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09-2.2, p = 0.015). CONCLUSION: Acute patient deterioration was comparable between ICUR- and NP-led MET calls. NP-led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.
Subject(s)
Medical Staff, Hospital/standards , Nurse Practitioners/standards , Outcome Assessment, Health Care/statistics & numerical data , Patient Care Team/standards , Aged , Aged, 80 and over , Female , Humans , Male , Medical Staff, Hospital/statistics & numerical data , Middle Aged , Nurse Practitioners/statistics & numerical data , Outcome Assessment, Health Care/methods , Patient Care Team/statistics & numerical data , Propensity Score , Quality Indicators, Health Care/statistics & numerical dataABSTRACT
Several women who undergo treatment for breast cancer experience cancer-related cognitive impairment [CRCI] commonly known as 'Chemobrain' or 'Chemofog'. However, many oncologists and other cancer clinicians are unaware of the high prevalence and severity of these symptoms. Few qualitative studies on the topic provide a comprehensive description of this phenomenon. This study provides a detailed description of women's experiences of CRCI, its impact on daily life and care received for it following treatment for breast cancer in Australia. Experiences of CRCI included difficulty in remembering things and recalling previously known tasks, inability to stay focussed on a task and other symptoms. The impact on daily life included economic, psychosocial and minimal impacts. Participants described both good care received as well as the clinical team's lack of understanding of CRCI. We conclude that CRCI in women treated for breast cancer affects memory and attention and has a significant impact on women's lives. Care provided for CRCI is inadequate in Australia. The economic and psychosocial impacts on women's daily lives coupled with increasing rates of survivorship highlight the need for more resources to be allocated for the management of these symptoms.
