The COAT & Review Approach: How to recognise and manage unwell patients by Nicholas Chrimes - Read Online
The COAT & Review Approach
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This manual provides junior healthcare workers with a simple structured approach which can be used to assist them in the early recognition of the deteriorating patient. It also provides a format for approaching the unwell patient which prioritises identifying and correcting immediately life-threatening problems.

Published: Nicholas Chrimes on
ISBN: 9781301796519
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    by Stuart Marshall

    The clinical complexity of patients in hospital environments is becoming greater. Patients are generally older, have more co-morbidities and are taking more medications prior to admission than ever before [1]. Given this change in demographic it would be reasonable to expect that hospital patients have fewer physiological reserves before they suffer any clinical deterioration and become critically ill.

    Deteriorating patients are common on the wards. A recent survey showed that 1 in 25 patients breach physiological criteria for activating systems for more help, however less than half of these patients receive such help [2].

    Identifying, stabilising and treating clinically ill patients is a key concern of all health professionals. All too often patients on the ward deteriorate without adequate assessment or basic supportive measures being implemented [3]. The recognition and subsequent care of the deteriorating patient has been a concern of many professional groups in the last few years, including international groups such as the World Health Organization [4].

    Physiological criteria are available in most hospital settings to help remind staff what the danger signs are. Some hospitals have adopted observation charts that have these abnormal physical signs displayed prominently to visually represent what requires action (Fig 1).

    Fig 1: An Example of abnormal physiological criteria

    The MET (Medical Emergency Team), which is the term generally in use in Australia, refers to a medically led team that is immediately available when called, usually consisting of critically care trained specialist doctors and nurses. A common alternative terminology is the ‘Rapid Response System (RRS) or Team (RRT) that refers to any team that attends a critically ill patient. Such a team is activated in these settings when a patient exceeds specific physiologic parameters like those outlined above .

    MET calls have been shown to halve mortality and double survival from cardiac arrest if they are called before the patient is too far-gone [6]. The MERIT trial was a cluster randomised trial (some hospitals had a MET team, some didn’t) that did NOT show improved survival [7], but most of the patients that didn’t benefit in the MET team hospitals