Delayed Emergency Team Calls and Associated Hospital Mortality

Chen, Jack; Bellomo, Rinaldo; Flabouris, Arthas; Hillman, Kenneth; Assareh, Hassan; Ou, Lixin

doi:10.1097/ccm.0000000000001192

Cited by 78 publications

(84 citation statements)

References 19 publications

(35 reference statements)

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“…In this light, in a recent issue of Critical Care Medicine, the study by Barwise et al (7), which found a significant relationship between delayed RRT activation and increased hospital mortality and morbidity as well as increased length of stay in a tertiary care hospital, is important in helping our understanding of the effectiveness and implementation of a RRS: 1) these findings are consistent with other similar studies (8)(9)(10)(11)(12)) that all showed a significant relationship between delayed calls and increased hospital mortality (it was estimated that every 100 delayed calls were associated with an extra 13 deaths by a multicenter study) (12); 2) the consistency and robustness of such findings across different studies conducted at different settings provided pivotal evidence that nondelayed RRT activation could save more patient lives and support the notion that a RRS actually can save patient lives; 3) the rate of delayed calls in the current study is high (57%, in comparison with 29% reported in a large multicenter study which was based on a more relaxed delay call definition [> 15 min given the exist calling criteria (12) compared with the current study of using > 1 hr as the cutoff]); 4) the substantial proportion of delayed calls highlighted that despite the promises, much more could be done to improve the compliance of RRTs and RRSs to save patient lives; 5) the study included a large number of RRT calls (1,227) in 2012 in an institution with an RRS since 2007. It is especially important to recognize that delayed calls to a RRT not only occurred in a hospital with a newly implemented RRS.…”

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confidence: 79%

Saving Patients’ Lives Through Activating a Rapid Response System

Chen¹

2016

Critical Care Medicine

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Commission, it has gained wide acceptance and has been implemented across many hospitals. However, despite the clear clinical intuition underlying the RRS concept and its popularity, several studies have failed to show a significant improvement in patient outcomes, in particular, in reduced patient mortality (2). Such results have led to controversy regarding its effectiveness. The RRS concept is a hospital-wide intervention with the intention and promise to save patient lives. However, among the 10 patient safety strategy systematic reviews commissioned by the Agency for Healthcare Research and Quality (3), the RRS, as a patient safety strategy, was not recommended or included in the list of "Strongly encouraged" strategies but only included in the list of "Encouraged" (4). This is despite strong evidence supporting its possible dose-response effect (more rapid response team [RRT] calls and lower hospital mortality) in the largest study ever conducted in this field (5) (i.e., a 23-hospital cluster randomized controlled trial) as well as the long raised issue of how the evidence related to complex system intervention in patient safety should be assessed and policy recommendations made (6).In this light, in a recent issue of Critical Care Medicine, the study by Barwise et al (7), which found a significant relationship between delayed RRT activation and increased hospital mortality and morbidity as well as increased length of stay in a tertiary care hospital, is important in helping our understanding of the effectiveness and implementation of a RRS: 1) these findings are consistent with other similar studies (8-12) that all showed a significant relationship between delayed calls and increased hospital mortality (it was estimated that every 100 delayed calls were associated with an extra 13 deaths by a multicenter study) (12); 2) the consistency and robustness of such findings across different studies conducted at different settings provided pivotal evidence that nondelayed RRT activation could save more patient lives and support the notion that a RRS actually can save patient lives; 3) the rate of delayed calls in the current study is high (57%, in comparison with 29% reported in a large multicenter study which was based on a more relaxed delay call definition [> 15 min given the exist calling criteria (12) compared with the current study of using > 1 hr as the cutoff]); 4) the substantial proportion of delayed calls highlighted that despite the promises, much more could be done to improve the compliance of RRTs and RRSs to save patient lives; 5) the study included a large number of RRT calls (1,227) in 2012 in an institution with an RRS since 2007. It is especially important to recognize that delayed calls to a RRT not only occurred in a hospital with a newly implemented RRS. Even for a mature RRS hospital, such a problem can be substantial and can persist; 6) the results reinforce the concept that not only failing to call (5) but also failing to call early can be fatal and defeats the purpose of a RRS.The authors...

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confidence: 79%

Saving Patients’ Lives Through Activating a Rapid Response System

Chen¹

2016

Critical Care Medicine

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“…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.…”

Section: Reduced Mortality?mentioning

confidence: 97%

Erfaringer med mobile intensivsykepleiere (MIS)

Sasa¹,

Jelsness-Jørgensen²

2017

Sykepleien

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“…In Table 2, the articles showed that delayed RRT activations are associated with increased hospital mortality rates, length of hospital stay, number of CRAs, and higher risk of admission to ICU. (8)(9)(10)(11) For patients admitted to ICU there is also increased mechanical ventilation time, length of hospital stay, and death. (9) There was no reduction of delayed activation even with monitoring of patients.…”

Section: Full Text N=26 Excluded N=7mentioning

confidence: 99%

Rapid response team: what factors interfere with its performance

et al. 2018

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Objective. Describe the knowledge in the literature related to factors that influence the performance of response teams. Methods. Integrative review of the literature of articles published in Portuguese, English or Spanish between 2006 and 2016. The descriptors hospital rapid response equipment, cardiac arrest and hospital mortality were used for the search in the PubMed/ Medline, Lilacs -Bireme and CINAHL bibliographic databases. Results. 19 studies were included for the analysis. The results were categorized in: sociocultural barriers and institutional policies, late activation of the rapid response team, composition and/or strengthening of the team's capacity, and use of facilitating tools. The sociocultural barriers found were: the presence of interprofessional hierarchies and beliefs, the limitations of institutional policies were related to the lack of training and human resources deficit. Late activations increased mortality, duration of hospitalization, and admission Descriptors: hospital rapid response team; heart arrest; hospital mortality; critical care.Equipo de respuesta rápida: ¿qué factores interfieren con su desempeño?Objetivo. Describir el conocimiento en la literatura relacionado con factores que influyen en el desempeño de equipos de respuesta. Métodos. Revisión integradora de la literatura de artículos publicados en portugués, inglés o español entre 2006 a 2016. Se emplearon los descriptores hospital equipo de respuesta rápida, paro cardíaco y mortalidad hospitalaria para la búsqueda en las bases bibliográficas PubMed/Medline, Lilacs -Bireme y CINAHL. Resultados. Se incluyeron para el análisis 19 estudios. Los resultados se categorizaron en: barreras socioculturales y políticas institucionales; activación tardía del equipo de respuesta rápida; composición y/o fortalecimiento de la capacidad del equipo; y uso de herramientas facilitadoras. Las barreras socioculturales encontradas fueron: presencia de creencias y jerarquías interprofesionales. Las limitaciones de las políticas institucionales se relacionaron con la falta de capacitación y déficit de recurso humano. Las activaciones tardías aumentaron la mortalidad, la duración de la hospitalización y el ingreso del paciente a la unidad de cuidados intensivos. Los equipos compuestos por profesionales de cuidados intensivos mostraron una reducción en la mortalidad y en la ocurrencia de paro cardíaco. El uso de nuevas herramientas no promovió cambios en la respuesta del equipo. Conclusión. Los factores encontrados en esta revisión influyen en el desempeño del equipo de

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Delayed Emergency Team Calls and Associated Hospital Mortality

Abstract: Among ward patients, emergency team activation in response to acute deterioration triggered more than 15 minutes after detection and documentation of instability is independently associated with an increased risk of ICU admission and death.

Cited by 78 publications

References 19 publications

Saving Patients’ Lives Through Activating a Rapid Response System

Saving Patients’ Lives Through Activating a Rapid Response System

Erfaringer med mobile intensivsykepleiere (MIS)

Rapid response team: what factors interfere with its performance

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