The substantial increase in medical knowledge along with the pursuit of enhanced outcomes and quality of care has led to significant subdivision of medical and surgical specialties. Physicians, regardless of level of training or scope of practice, should be able to efficiently and safely approach and manage a patient that is facing a medical emergency. In order to achieve a consistent and systematic level of proficiency to ensure safe patient care and positive outcomes, formal exposure and training in managing medical emergencies is critical. The Acute Medical Emergency Team (AMET) at Cleveland Clinic is a rapid response crew that attends approximately 5,000 activations annually on regular non-cardiac nursing floors for patients requiring medical intervention or escalation of care to critical care units. However, the current involvement of medical residents in the rapid response team process is minimal. We have recognized the need for developing formal training and exposure in the rapid response team skillset as a current academic opportunity for improvement.
The aim of this continuous quality improvement initiative is to provide formal training to the residents of the Cleveland Clinic Internal Medicine Residency Program in acute medical emergency management as participants of a multidisciplinary rapid response team for patients admitted to the hospital during the 2016-2017 academic year.
AMET is comprised of nursing staff, a mid-level provider, technicians, and a supervising staff physician (trained in Anesthesiology, Critical Care or Emergency Medicine). The AMET training for our residents will include a standardized two week curriculum with a didactic component focused on algorithmic approaches to the most common types of AMET activations: chest pain, hypotension, tachycardia, respiratory distress, hypertension, altered mental status, and seizures. In addition, a practical simulation of AMET scenarios using high fidelity simulation manikins in real patient rooms during normal work hours will allow residents to practice the approach to a medical emergency. Once the training is complete, residents will have the opportunity to participate as mid-level providers on AMET. In addition to focused AMET training, secondary measures will assess trainees’ degree of comfort in managing emergencies, and the indirect reduction in number of AMET activations as a result of enhanced training.
Formal exposure to rapid response for inpatient medical emergencies, excluding cardiopulmonary arrest, is lacking in current internal medicine residency training. A formal curriculum that provides residents with skills for safe and effective participation in multidisciplinary adult medical emergency teams will enhance overall hospital medicine training, and increase the comfort level of residents participating in rapid response activations.