Koichi agreed to work in 6ICU instead of his home unit. One of his patients that shift was downgraded and had orders to be moved out of 6ICU. Although a bed was released on ACU for this patient, Koichi made it known that the patient was not a good choice for downgrade. The patient was not as stable as others perceived, and Koichi felt he was likely to decompensate. His colleagues got the message. As more time passed, the patient deteriorated despite interventions and warranted intubation. Unfortunately, the tube came out and reintubation was extremely challenging. Since Koichi's encounter with the patient, he was taken to the OR for an exchange of his endotracheal tube and he decompensated while on the OR table (to the point of arrest). There was about a 99.9% likelihood that the patient would have decompensated on ACU (just as he did in ICU), had he been moved.
Due to ACU nurses having 4-5 patients and more geographical distance to cover, there is a significant chance that (had the nurse not been in with him/ very close when he decompensated) he may have arrested instead. Since he was in ICU (1-2 patients per nurse and many more resources immediately available) and Koichi's level of concern was already elevated, he and others on his team were immediately present as his condition worsened. Koichi's knowledge, expertise, judgment, nursing "6th sense", assertiveness, advocacy for patients, and willingness to express his concerns clearly made a huge difference for this gentleman.