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Vital Signs

HERT response team has cut code blues at DHMC by 40%

By Laura Stephenson Carter

The patient's condition is deteriorating. He needs critical-care help—and fast. But he's not in the intensive care unit (ICU), where such expertise is readily available. "Call HERT," someone orders. In less than three minutes, a critical-care team is on the scene.

Blue: HERT—Hitchcock Early Response Team—is a new initiative to aid rapidly deteriorating patients before they "code." That term is short for "code blue," called when an unconscious patient goes into cardiac or respiratory arrest.

"We know we've saved lives," says Scott Slogic, who as director of respiratory care and life safety oversees HERT. The team's critical-care registered nurses, respiratory-care practitioners, and critical-care providers collaborate with the patient's physicians to develop a plan, provide treatment, and in some cases help transport the patient to the ICU.

The number of code-blue calls at DHMC has dropped thanks to HERT, which began earlier this year, and to the STAT Airway Team, another emergency response initiative that began in 2005. Typically, DHMC averages 200 to 225 code blues a year. But this year Slogic predicts that there will be only about 125. HERT has been activated 80 times since January.

The HERT team not only saves lives and reduces the number of days patients spend in the ICU, but "it helps improve everyone's ability to recognize, assess, and treat patients who are demonstrating early signs of deterioration," says Slogic.

Signs: Such early signs include respiratory distress (increased oxygen use and a breathing rate of more than 30 or fewer than eight breaths a minute); choking; acute mental status change; or a heart rate of more than 130 or fewer than 40 beats a minute. If a nurse, another provider, or even a family member is concerned, the decision may be made to call HERT.

"The signs can be quite subtle in the early phases," says Dr. Christopher Cook, a leadership preventive medicine resident. He and Dr. Stephen Surgenor, a critical-care specialist, are HERT's physician leaders. "Often it's nurses' intuition [or] a resident recognizes that something is not quite right," Cook says.

The concept of hospital early response teams began in Australia and has only recently begun to catch on in the United States, he adds.

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