Med to test our compliance to the model and to critically analyze its usefulness as

Med to test our compliance to the model and to critically analyze its usefulness as a triage tool. Method: We performed a prospective audit of all adult referrals for admission to our 22 bed multidisciplinary University ICU between 13 November and 13 December 2001. Patients were categorized according to the guidelines by two investigators not involved in the triage decision. The proportion of patients admitted in each priority group was calculated.Results: The audit consisted of 117 patients. The mean age was 58 and the mean Mortality Prediction Model at admission (MPM II0) 0.37. The results obtained are shown in the Table overleaf.Critical CareVol 6 Suppl22nd International Symposium on Intensive Care and Emergency MedicineTable Number of patients ( of total) 84 (72 ) 17 (15 ) 7 (6 ) 9 (7 ) Number admitted ( of admission) 79 (94 ) 11 (65 ) 3 (43 ) 0 (0 )Priority category 1 2 3Conclusion: Our triage decisions complied well with the guidelines. This is evident from the high admission rate in the Priority 1 group and a reducing admission rate in the subsequent categories. Due to our limited health resources some category 1 patients were refused. In healthcare systems with limited resources a method of selecting between category 1 patients may be necessary. Reference:1. Guidelines for intensive care unit admission, discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 1999, 27:633-638.P246 Clinical outcomes in a controlled trial of early identification and rapid systematic treatment of shock, modeled after the KKL-10 biological activity trauma systemF Sebat, D Johnson, S Moore, K Henry, M PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20725042 Saari Redding Medical Center, 1100 Butte Street, Redding, CA 96001, USA Hypothesis: Early identification and rapid systematic treatment of shock will improve outcomes. Inclusion criteria: Sustained inadequate tissue perfusion not responsive to initial volume resuscitation. Hypotension. SBP < 90, MAP 60, not corrected with one liter rapidly infused crystalloid and one or more of the following: or Normotension. With three of the following: Temperature 36; Cool extremities or skin mottling; Altered mental status; RR 20; Oliguria; Lactic acidosis or BE ?. Identified to be in shock by the caregiver (i.e. septic, cardiogenic, hypovolemic). Exclusion criteria: Trauma, acute MI, patients already receiving mechanical ventilation/pressors, and patients who are not candidates for ACLS. Methods: Patients at Redding Medical Center between 1998 and 1 June 2000 in shock (control group) were treated in the standard fashion. The outcomes of those patients were compared to the outcome of patients at Redding Medical Center in shock after 1 July 2000 (treatment group). Both groups had the same inclusion and exclusion criteria and assessed for severity of illness using APACHE III. During the month of June 2000 intensive education to all nursing personnel, Emergency Department physicians, intensivists, surgeons, interventional radiologists, and medical staff at large was undertaken for the purpose of improving earlier identification and treatment of shock. Beginning 1 July 2000 standardized treatment protocols utilizing best practice were implemented for the EMS, Emergency Department, critical care units and generalTable Time intervals (hours:min) Shock alert Average for control n Average for treatment n NA 0:48 75 ICU admit* 4:25 75 2:38 103 2 l Fluid*** 5:21 76 2:31 101 Central line 3:29 33 2:42 68 PA line* 4:23 53 3:.