What does STAT really mean????

Okay, so I'm a new respiratory therapist and my pager goes off. I look at it and see, "EKG in recovery STAT!" What does this mean? What do I do?

I am taught that if something is STAT, that means that immediately or without delay. It means I must drop everything I am doing and rush to the patient. In my mind, it means the patient is in dire straights, and my services are needed immediately to fix the patient.

So, I do just that: I stop the breathing treatment I am presently doing, even though my patient is somewhat short of breath. I have to do this because, by my definition of STAT, someone needs me more than this guy. So I rush down to recovery and...

... what I find is a patient who is awake and alert and in no apparent respiratory distress. Okay, he is fine. He is talking. When asked, he says he has no chest pain. And the nurse says, "Yes, the doctor just wanted an EKG before he left the unit, and didn't want to wait."

Eh! This is where the respiratory therapist gets a little perturbed. He grumbles under his breath, but he does the EKG to keep the peace. He is pleasant to the patient, pleasant to the nurse, and pleasant to the doctor. Then he quickly returns to the person in need of a treatment.

Still a note is made in the back of the therapist's mind: don't rush the next time the term STAT is used. And, a few hours later, another STAT page to recovery is observed on the beeper. This time, the RT finishes what he is doing and then walks to recovery.

So, you see, in this way, the word STAT is watered down so that it is essentially irrelevant. The word STAT becomes no more useful than that word ASAP, which means As Soon As Possible. To me, by my definition, ASAP means finish what you are doing and then come down.

You see, at some point the watered down version of STAT is going to get me and a patient in trouble. However, considering about 99% of STAT pages are not to save a life, it would be frivolous to have an RT rushing to the scene of every STAT page.

Now, this brings me to the definition of STAT that doctors go by. Doctors, or so it seems to me, define it as "per my convenience, I need you to get this done immediately, or without delay."

It does not matter what you are doing, you have to drop it to rush to the scene of the STAT page. It doesn't matter who the patient is you are presently taking care of, or how sick your patient is: you drop what you are doing and run.

But I do not like this definition. I wish there was a more universal definition of STAT and ASAP. This would help prevent frustration on both the part of the therapist, nurses, and physicians.

Here's how I would define these terms:

• STAT: You are needed immediately, or without delay, because something you do can help save this person's life. A delay might result in increased morbidity or mortality. 
• ASAP: You are needed as soon as you finish up what you are currently doing. A delay will not result in increased morbidity or mortality, although your services are requested as soon as you can possibly fit them into your schedule. 
• AYC:  This means at your convenience. Your services are needed, although you can do them whenever they fit into your schedule. There is no rush to get them done. In most instances, this is assumed. 

These new definitions allow physicians to get the rapid service that they require, although they also allow the therapist time to prioritize. This would result in greater satisfaction of workers, while making sure the patient's get the care they need when they need it. What do yo think? 

STAT pre-operative EKG

So I get called STAT to do an EKG on a pre-operative patient. Of course I know that 99.934 of the time I've ever gotten paged STAT to go there it's just because the patient is having surgery and needs a pre-surgery EKG, so I stop and go to the bathroom on the way, and then I stop in the department where my boss has a few questions for me. You see, fool me 300 times and shame on me, fool me the 301st time shame on you.

So I get down there and I don't say, "I'm pissed at you for paging me STAT," however I do mention, "STAT" every chance I get:

• Where's the STAT EKG?
• Does the patient the STAT EKG is on have chest pain?
• Why was the EKG ordered STAT?

You know, I play this game. The response I got this time was: "We needed to get the EKG done because we need to get the patient to surgery so we can free up this bed."

Sometimes I get, "The doctor ordered it that way.

I have no problem with that, but don't call me STAT. Don't make me pull the EKG from another department to do a STAT treatment, because if a patient comes into the other department and truly needs a STAT EKG he won't be able to get his STAT EKG done because I'm doing your STAT EKG so you can free up a bed.

I don't care if the doctor ordered it that way, or if the tooth ferry ordered it that way. It's disrespectful to me and every patient who truly needs a STAT procedure to order your procedure STAT just so you can empty a bed.

For more information, see RT Cave Rule #6.

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Dear doctors: don't abuse the word STAT

I dare you to hang this note on your bulletin board for doctors to see.

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Dear Doctor:

If the patient has been in afib for six hours, has a long history of afib, and shows no signs of respiratory distress, notes no signs of respiratory distress, has a normal spo2, and has no chest pain, then a STAT EKG is not in order.

Now, you may order an EKG as "Now" or "ASAP," but STAT is not appropriate. When we hear the word STAT we think that if we are not at the patient bedside in a matter of minutes the patient will die. If you abuse this important word, you diminish its value, and desensitize us to that word.

Thus, please, do not order a procedure STAT unless you actually mean you want us at the bedside immediately. If you order me to the bedside STAT because you don't want to wait, or because you're annoyed with the nurse, or because you want it before a surgery, I'm going to catch on and STAT to me is going to mean no more than ASAP or NOW.

So, please, from this day forth, do not order procedures STAT unless the word STAT is what you really want.

Thank you: your humble respiratory therapist

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I dare you.

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Word of the Day:Provocation: the act of provoking; something that incites, instigates, angers, or irritates

I imagine one might see this more as an act of provocation as opposed to educating.

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Please don't abuse the word STAT

If I am called to the emergency room STAT and I get down there and have to stand around for five minutes before the patient even arrives, then I didn't' need to be called STAT.

If I am called to the emergency room STAT only to be told the ambulance is still 5 minutes out, I didn't need to be called STAT.

If I am called to recovery STAT only to find out the surgeon wanted a pre-operative EKG, I didn't need to be called STAT.

If I get called to a patients room STAT, and learn the doctor wanted the routine ABG or EKG done before he had to leave town to go fishing, I didn't need to be called STAT.

That in mind, allow me to restate here an old RT Cave Rule:

RT Cave Rule #6: STAT means that you need to get to the patients side right now. We are talking about a life and death situation.

That said, there is another rule that must be re-emphasized about the word STAT, and that's this: if you're going to abuse the word STAT, then you are going to desensitize RTs to its meaning.

Thus, if you keep calling me STAT for BS reasons, I'm going to stop dropping what I'm doing when I hear it. This brings me to our latest RT Cave Rule:

RT Cave Rule #37: If you don't want to desensitise RTs to the word STAT, make sure you don't abuse the word STAT.

I think the word STAT is one of the most important in the entire hospital industry, so it must not be abused. We RTs are just as busy as doctors and nurses and are required to prioritize therapies. Don't force us to sacrifice the care of one patient for your inappropriate STAT call.

There are more appropriate ways to inform or page the RT of an impending situation. For examle, you can type the following page:

1. The doctor wants you in room 231 ASAP
2. Ambulance 5 minutes away
3. EKG in ambulatory ASAP

Any further questions you can contact me:

I'm going to be written up -- I hope

I'm going to be written up, and I'm happy about it.

About seven hours into my shift I had a patient with a bad heart of whom the ER doc had already decided to ship. I had a bad feeling about this patient, so I decided to hang out in ER until the patient was secured into the ambulance, and the ambulance was gone.

Leaning against the wall, being cool, I casually looked down at the counter and saw that someone had written something on a note pad. This is what it said: "Respiratory did not respond to do an EKG after 2 pages."

I smiled, stood by coolly, and pretended I didn't see it. Most ER nurses understand that I am the only RT on duty, and that my other patients are just as important as ER patients, but this new nurse, her name is Mary, hasn't figured that out yet.

During my recent stay in the hospital, she was the only nurse who didn't treat me like royalty. In fact, when she was my ER nurse, that was the first time I had met her. Now I'm quite certain that not only is she a bitch from the patient POV, she is also a bitch from this side too. She is a rare and unfortunate scar on an otherwise awesome staff here at Shoreline.

Despite my opinion, which is subject to change once I get to know her, I continued to treat her with respect, and I continued to coolly smile at her each time I passed her. And, to my surprise, she was quite nice to me the rest of the night. She even smiled once.

As you guys know from a previous post, I have a proposal for ER EKGs that I have yet to take to the powers that be here at Shoreline. If I get written up here, I am going to use this as a prime opportunity to state my case for STAT reform.

Instead of paging me "EKG in ER" I think I should be paged "STAT EKG in ER" or "Just because EKG in ER" so that I can prioritize appropriately. However, I did tell this to a nurse once, and she paged me STAT for every EKG, because, as she said, "All ER EKGs are STAT."

"No they are not," I said.

"Everything ordered down here is STAT."

"That's not necessarily true." And I proceeded to give her many examples: Treatment for sputum induction, treatment on a not SOB patient, pre-op EKGs, etc.

I said, "If you start paging me STAT to all EKGs, then I'm going to get numb to the word STAT. It's not fair to my patients on the floor if I drop what I'm doing every time I get a STAT page, especially when the EKG in ER isn't needed."

When this nurse I do not like paged me the first time, and to my defense, I was with another patient. I did get the page. I was tied up in another room. And, since about 80% of ER EKGs are done just because, I figured I'd finish up what I was doing before going down to ER. And, lo and behold, I received a second page three minutes later, and still decided to finish up what I was doing.

I was swamped all night.

Okay, yes I could have called. I am at fault there. However, most of the time I call to say I'm going to be a while getting down there, I get down there 20 minutes later to find the EKG is still not done, so why bother calling.

Now, you might be thinking, "If they thought to page you a second time, didn't you think that perhaps they thought the EKG needed to be done urgent?"

No. The reason I didn't think that was because ER always pages me three minutes after the initial page, especially if I don't get down there right away. I get tired of it, especially when I drop what I'm doing and the patient has an EKG ordered for a hang nail or something stupid like that.

I'm the kind of RT who gets along with everybody for the most part. I never complain. In fact, just last night I walked into a room to do a STAT EKG on a patient who was being packed up to be shipped to the CCU, and I observed the patient's NC was hooked up to a tank.

"Is that tank even on," I said while hooking up my leads.

"Yeah, I'm sure of it," the young nurses aid reassured me.

I casually unplugged the tubing from the tank and hooked it to the flowmeter, and turned the flowmeter on. Then I checked the O2 tank. Yes, it was on to 2lpm, but there was something she didn't notice: the tank was empty.

Now, instead of jumping all over her and telling her she was a stupid ass like some people might do, I used this as a teaching opportunity. She probably thinks I'm going to write her up. I won't.

Why won't I write her up? Because I know that some day I'm going to do something stupid. We are a team. We need to stand up for one another.

This ER nurse however. I am very confident that once I get her trained I will get along with her just fine, so long as there is any humanity in her. In the meantime...

I hope she writes me up.

Need STAT reform STAT

Aside from the need for bronchodilator reform, I've been thinking lately that we also need some major STAT reform. It's getting the the point that the word STAT has lost all credibility.

"RT STAT to ER," wailed overhead. I had a SOB patient in need of a treatment, but what was I to do? I rushed down to ER to find a kid in no respiratory distress. He didn't even need a treatment. I rushed back up to care for my SOB patient.

When I hear that word "STAT" that's what I think: drop what I'm doing and go (with a few exceptions.)

RT Rule #6: STAT means that you need to get to the patient's side right now. We are talking about a life and death situation.

I've been called to a room stat to do an EKG, only to find out the doctor wanted it done so he could go home. I consider that abuse of the STAT system.

I've been called to pre-op STAT to do an EKG prior to surgery on a scheduled surgery. Those EKGs should be completed way before the surgery so they can be inerpreted.

I've been called STAT to induce a sputum. Once I was called to STAT NT suction patient for this.

After I very reluctantly performed this not indicated and traumatic procedure, the nurse cornered me. He said, "I called that STAT because of the pneumonia protocol, and we had to give the antibiotic within four hours."

"That's a silly reason to call me STAT," I said. And you're lucky I didn't have anything else to do, or I wouldn't have come down right away either. I'm not letting my SOB patients suffer for this.

I was even called to do a STAT Halter Monitor once, but that ended up being the ER staff fooling around with me because they knew I hated doing Halters in ER. I suppose I deserved that one.

The first thing you learn as an RT is that a page to ER is considered a STAT page. I was told that I should be down in ER in about 5 minutes.

When I first started working here I was told by the ER staff how impressed they were at how quickly I got down there to do EKGs and treatments. "You get down here almost twice as fast as any other RT."

I was perplexed. I thought we were supposed to be in ER within 5 minutes. I thought we were supposed to drop whatever we were doing and get down there.

Then I caught on. I realized that I was quitting in the middle of a breathing treatment, rushing down to ER, and doing an EKG on a patient who had leg pain, or abdominal pain, or bad fingernails or something stupid like that. Or I'd get called down there to do a treatment on a kid with a cold.

Either that or I'd get down there and the nurses were putting in a catheter and tell me I had to wait. After a few months of waiting 10-15 minutes each time this happened, I decided I could better utilize my time.

I tried to go to my boss, but they had more pressing issues to deal with. That was a dead end. I learned that other RTs had done the same thing when they first started as RTs. Now we are all slow. According to some ER RNs, we are slow getting to ER because we are lazy.

That's fine, call me lazy, but you guys need to learn how to use the word STAT. I would like a reform of the ER paging system. When I think of STAT I think of running. I think that if I don't get there right away the patinet might die or have prolonged suffering.

One day an ER nurse was blunt with me. "What took you so long to get down here?"

"I'm sorry, I'm swamped," I said. It was true.

"You should at least call so we could do it."

"I was at a code."

Twenty-minutes later I received another page to ER for an EKG, and this time I really was busy and called. An hour later I made it down to ER and the EKG was still not done.

To be fair, most ER staff at Shorline are very understanding that sometimes RT is busy, and that we have to prioritize. And, as it turned out in this case, the nurse that did complain was a rental nurse not familiar with our hospital.

And, even while ER procedures are considered STAT, the people who order them are simply following the current protocol and, thus, doing there jobs.

To correct this problem, we at the RT Cave wrote the following letter. It was signed by all my fellow RTs:

To whom it may concern:

To speed up time from door to EKG for critical patients in the ED, and to allow the respiratory therapy staff leeway in prioritizing EKGs with important therapies on the patient floors, we propose the following paging protocol be instituted for all EKGs ordered in the Emergency Department (ED).

1.EKG Priority One: This page will be sent out for all EKGs ordered on highly critical patients such as obvious MI’s, life threatening arrhythmias, failing patients, etc. Upon receiving this page, the RT will drop what he is doing and run as fast as he can to the ED. If RT is unable to complete the EKG within 5 minutes, the ED will be called and the ED staff will complete the EKG.

2. EKG Priority Two: This page will be sent out for all EKGs that fit under the ACLS protocol where the EKG must be completed within 10 minutes of the patient’s arrival in the ED. Upon receiving this page, the RT should be in the ED within 10 minutes to complete the procedure. If RT is unable meet this time frame, the ED will be called and the ED staff will complete the EKG.

3. EKG Priority Three: This page will be sent out for all EKGs that do not fit under the ACLS protocol, the patient is stable, and a time frame from door to EKG is not essential. Upon receiving this page, the RT will have leeway to complete other
essential procedures prior to arrival in the ED. This page will also be utilized for all pre-op patients, and any patient currently unavailable due to use of commode, bathroom, gone for x-ray,CT, etc.

Ideally, priority three EKGs should be completed within 20 minutes from time of page. If RT is unable to meet this timeframe, the ED will be called with an estimated time of arrival. In some cases,the ED staff may decide to complete the EKG and, if this occurs, RT will be notified the procedure has been completed so they don't have to rush down when they finish the task at hand.

If the ER staff is called to do an EKG, and the EKG is not completed in a timely manner, the RN will have to order pizza for all the RTs on duty. If this is not possible, the total sum of $50 will be extracted from the RNs paycheck and set aside for an end of year RT party.

We believe the implementation of this protocol is essential to improving staff time management, and, more important, improving patient care.

Sincerely, The RT Staff

We understand it's a hell of a lot easier to be called lazy (we're used to that) than to try to change policies and procedures that make no sense. But we had to try with this letter.

If this works, we will tackle STAT ER treatments ordered on patients not having bronchospasm next.