In group 1, we observed that MICNs were contacted to give advice to ward nurses, which was also noted in group 2. The high number of cases where ward nurses requested advice from MICNs may be an indication that it was easy and safe to contact MICNs for this reason. Providing support and training in different procedures was also covered in the definition of advice. This is in line with the purpose of establishing MICNs, and corresponds with the recommendations in other studies (15).
In group 2, supplying 02 in cases of hypoxaemia, intravenous fluid for hypotension and medication were the most widely used measures. These measures are easy to carry out, as described in other studies (19, 24). The ‘bedrest’ measure was also used frequently, but we have not found descriptions of this measure in international studies. This measure may be considered to be of little importance in an emergency situation, despite being described as a basic nursing measure in nursing literature (25).
It is known that patients who suffer a severe deterioration in their condition, including patients in cardiac arrest, show signs of deterioration several hours earlier. In order to prevent catastrophic outcomes, these warning signs must be treated at an early stage (26–28). In a meta-analysis from 2010, it was not possible to conclude that RRTs reduced mortality (29). However, in the latest meta-analyses, Solomon et al. (8) and Maharaj et al. (9) concluded that RRTs/METs reduced mortality and the occurrence of cardiac arrest.
Our study was not designed to capture these peripheral points. On the other hand, the findings show that only 16 of the patients who MICNS were called out to were transferred to an intensive care unit. Since this study has only used the registration form that was used by MICNs and has not mapped long-term data, we cannot rule out the transfer of patients to an intensive care unit at a later date. Hillman et al. (16) found that METs did not contribute to any significant reduction in the number of admissions in intensive care units, while a Dutch study found a downward trend in the number of intensive care admissions (3).
We also found that most (75 per cent) of the patients admitted to an intensive care unit had respiratory problems. We assume that the majority of these needed respiratory support using, for example, Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BiPAP). Future studies aimed at mapping efficacy are needed in order to examine the clinical effect of MICNs, including early transfer to an intensive care unit, or reduced transfers due to early intervention.
Where call-out times and the time taken to initiate measures exceed 15 minutes, a poorer prognosis may be expected (22). Our survey showed that MICNs had a median call-out time of 5 minutes. Silva et al. (1) reported a call-out time of less than 2 minutes for METs. The fact that the MICNs’ call-out time in our study was more than twice that of the other study may be because our hospital covers a large area and some departments are located a considerable distance from the MICNs’ base. Other studies reported call-out times of 4.5 and 12.3 minutes respectively (17, 19).
Weaknesses of the study
In addition to the obvious weaknesses of a cross-sectional study, this study also has a short period of inclusion. It also only covers a small number of call-outs and patients. The finding that patients mainly had respiratory problems may also be due to seasonal variations. Despite these weaknesses, we believe that the study provides valuable clinical information that can be used in the further development of these types of services.
Mobile intensive care nurses are usually called out to medical patients whose condition has deteriorated due to respiratory problems. Future studies should assess whether it is possible to identify symptoms of deterioration at an earlier stage, so that targeted treatment can be initiated sooner and transfer to a higher level of treatment can potentially be avoided.
The measures initiated for the patients are, in principle, simple measures that nurses with broad knowledge and good clinical knowledge can deal with. Future studies should therefore examine whether such a role can also be filled by advanced clinical nurses and not exclusively intensive care nurses. Mobile specialist nurse models can also potentially be tested in the primary health service.
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