Delayed Rapid Response Team Activation Is Associated With Increased Hospital Mortality, Morbidity, and Length of Stay in a Tertiary Care Institution

Barwise, Amelia; Gajic, Ognjen; Jensen, Jani R.; Herasevich, Vitaly; Pickering, Brian

doi:10.1097/01.sa.0000489976.94994.f7

Cited by 22 publications

(48 citation statements)

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“…At a minimum, RRT events should be considered as triggers for a diagnostic review by the responding team, which consists of a critical care fellow, a critical care respiratory therapist, and an ICU nurse. 36 This has implications for the composition of the team and speaks to the need to involve a diagnostician as part of that team. Indeed, our trained physician reviewers failed to establish an agreement (18%) or were uncertain about the presence of DE (7%) in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk

et al. 2020

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Background Although diagnostic error (DE) is a significant problem, it remains challenging for clinicians to identify it reliably and to recognize its contribution to the clinical trajectory of their patients. The purpose of this work was to evaluate the reliability of real-time electronic health record (EHR) reviews using a search strategy for the identification of DE as a contributor to the rapid response team (RRT) activation. Objectives Early and accurate recognition of critical illness is of paramount importance. The objective of this study was to test the feasibility and reliability of prospective, real-time EHR reviews as a means of identification of DE. Methods We conducted this prospective observational study in June 2019 and included consecutive adult patients experiencing their first RRT activation. An EHR search strategy and a standard operating procedure were refined based on the literature and expert clinician inputs. Two physician-investigators independently reviewed eligible patient EHRs for the evidence of DE within 24 hours after RRT activation. In cases of disagreement, a secondary review of the EHR using a taxonomy approach was applied. The reviewers categorized patient experience of DE as Yes/No/Uncertain. Results We reviewed 112 patient records. DE was identified in 15% of cases by both reviewers. Kappa agreement with the initial review was 0.23 and with the secondary review 0.65. No evidence of DE was detected in 60% of patients. In 25% of cases, the reviewers could not determine whether DE was present or absent. Conclusion EHR review is of limited value in the real-time identification of DE in hospitalized patients. Alternative approaches are needed for research and quality improvement efforts in this field.

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Section: Discussionmentioning

confidence: 99%

Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk

et al. 2020

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“…It is already well known that a delayed RRS response is associated with a poor patient outcome [25][26][27]. Recently, the published "Quality metrics for the evaluation of RRS" study de ned predictable IHCA as CAs occurring in hospitalized ward patients who met the hospital's escalation threshold at least 30 minutes prior to and within 24 hours of the event [28].…”

Section: Performance Evaluation and Statistical Analysismentioning

confidence: 99%

A Multicenter Validation Study of the Deep Learning-based Early Warning Score for Predicting in-hospital Cardiac Arrest in Patients Admitted to General Wards

Lee

Cho²,

Kwon³

et al. 2020

Preprint

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Background: The recently developed deep learning (DL)-based early warning score (DEWS) has shown a potential in predicting deteriorating patients. We aimed to validate DEWS in multiple centers and compare the prediction, alarming and timeliness performance with those of the modified early warning score (MEWS) to identify patients at risk for in-hospital cardiac arrest (IHCA).Methods: This retrospective cohort study included adult patients admitted to the general wards of five hospitals during a 12-month period. We validated DEWS internally at two hospitals and externally at the other three hospitals. The occurrence of IHCA within 24 hours of vital sign observation was the outcome of interest. We used the area under the receiver operating characteristic curve (AUROC) as the main performance metric.Results: The study population consisted of 173,368 patients (224 IHCAs). The predictive performance of DEWS was superior to that of MEWS in both the internal (AUROC: 0.860 vs. 0.754, respectively) and external (AUROC: 0.905 vs. 0.785, respectively) validation cohorts. At the same specificity, DEWS had a higher sensitivity than MEWS, and at the same sensitivity, DEWS had a lower mean alarm count than MEWS, with nearly half of the alarm rate in MEWS. Additionally, DEWS was able to predict more IHCA patients in the 24 to 0.5 hours before the outcome.Conclusion: Our study showed that DEWS was superior to MEWS in the three key aspects (IHCA predictive, alarming, and timeliness performance). This study demonstrates the potential of DEWS as an effective, efficient screening tool in rapid response systems (RRSs) to identify high-risk patients.

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“…17,18 As a result, delays in CCOT activation are common. 19 Three recent studies have shown that a delay in CCOT activation is associated with worse patient outcomes. [19][20][21] Nevertheless, none of these studies contained Canadian patients, limiting their external validity as it relates to the Canadian healthcare system.…”

Section: Résumémentioning

confidence: 99%

“…19 Three recent studies have shown that a delay in CCOT activation is associated with worse patient outcomes. [19][20][21] Nevertheless, none of these studies contained Canadian patients, limiting their external validity as it relates to the Canadian healthcare system. Furthermore, the impact of admitting service was not accounted for in the analyses.…”

Section: Résumémentioning

confidence: 99%

The impact of delayed critical care outreach team activation on in-hospital mortality and other patient outcomes: a historical cohort study

Tillmann

Klingel

McLeod

et al. 2018

Can J Anesth/J Can Anesth

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Delayed Rapid Response Team Activation Is Associated With Increased Hospital Mortality, Morbidity, and Length of Stay in a Tertiary Care Institution

Cited by 22 publications

References 0 publications

Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk

Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk

A Multicenter Validation Study of the Deep Learning-based Early Warning Score for Predicting in-hospital Cardiac Arrest in Patients Admitted to General Wards

The impact of delayed critical care outreach team activation on in-hospital mortality and other patient outcomes: a historical cohort study

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