Governance of Rapid Response Teams in Australia and New Zealand

Abstract

Rapid response systems (RRS) in hospitals in Australia and New Zealand (ANZ) have been present for more than 20 years but governance of the efferent limb-the rapid response team (RRT)-has not been previously reported in detail. The objectives of this study were to describe current governance arrangements for RRTs within ANZ and contrast those against expected implementation, using the Australian Commission for Safety and Quality in Health Care National Standard 9 (S9) as a benchmark. Assessment focused on S9 subclauses 9.1.1 (governance and oversight), 9.1.2 (RRT implementation), 9.2.3 (data collection and dissemination), 9.2.4 (quality improvement), 9.5.2 (call reviews), 9.6.1 and 9.6.2 (basic and advanced life support [ALS] skill set). We identified public and private hospitals across ANZ from government-maintained registers. Those reasonably expected to have an RRT were contacted and invited to participate. Responses were obtained via an online anonymised questionnaire. Three hundred and forty-two hospitals were contacted, of whom 284 (83.0%) responded. Two hundred and thirty-two hospitals submitted data, and the other 52 declined to participate or did not have an RRT. In hospitals with an intensive care unit (ICU), intensivist attendance at RRT calls occurred less often outside office hours (odds ratio, OR, 0.49, 95% confidence interval, CI, 0.32 to 0.75]). Where intensivists were not on the RRT, consultation with them about calls also occurred less often outside office hours (OR 0.39, 95% CI 0.22 to 0.66). Consultation with patients' admitting specialists occurred more often during office hours versus out of hours RRT calls and in private versus public hospitals. The presence of ICU staff on the RRT decreased the likelihood of admitting specialists being consulted about RRT calls (OR 0.66, 95% CI 0.47 to 0.93). Most hospitals maintained databases of RRT calls and regularly audited RRT activity (92% and 90% respectively). However, most (63.7%) did not make that information available beyond their hospital or local network. We concluded that the majority of hospitals in the ANZ region had governance mechanisms for their RRT. However, there was a notable lack of consistency, especially around specialist involvement and audit processes. Although some findings from this study are reassuring, there is still potential for improvement. Further development of guidelines and the establishment of a regional RRS database may assist with achieving this.

Comparison of clinical outcomes between nurse practitioner and registrar-led medical emergency teams: a propensity-matched analysis

“…The organization and governance of MET teams in different organizations are variable and are largely dependent on the availability of personnel [5]. To the best of our knowledge, there are no studies that directly compared the service delivery of NP leading MET calls on clinical outcomes.…”

“…These teams are called as critical care outreach teams, MET teams, patient at risk teams and high capability teams in different countries [3]. The teams are largely led by physicians [4,5]. The nurse-led MET teams are second most common model reported in the literature [6].…”

Model of rapid response teams in paediatrics and their influence on the quality and safety of inpatient care

“…In hospitals with an ICU, intensivist attendance at RRT calls occurred less often outside office hours. 3 So far, there have been no presentations or scientific arti� cles concerning the e��ects o� RRT operation in Polish paedi� atrics and their influence on inpatient child care safety. Nor have there been any articles concerning evaluation made by medical sta�� o� an RRTs model in a paediatric hospital.…”

Effect of a multi-faceted Rapid Response System re-design on repeat calling of the Rapid Response Team

“…[3,6,7] However, ever expanding RRS activity poses a logistical and resourcing burden for hospitals, as most RRTs tend to not be supernumerary, with staff rostered from other substantive roles. [4,8,9] Although adverse effects have not yet been attributed to team members leaving other duties to attend RRT calls, [10] the potential exists for these to occur. This risk could be magnified during concurrent RRT calls as resources are typically not available to provide a full response to more than one call simultaneously.…”