Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

Blotsky, Andrea; Mardini, Louay; Jayaraman, Dev

doi:10.1155/2016/1518760

Cited by 5 publications

(16 citation statements)

References 22 publications

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“…Two of the single studies reached similar conclusions, 17 , 19 and one study 18 showed a continuing significant trend of decreasing CA that was present before the implementation of the RRT, but unchanged by its introduction.…”

Section: Resultsmentioning

confidence: 59%

“…Among single studies, Blotsky et al 17 found a decrease in ICU admissions from 4.8 to 3.3 per 1000 patient days ( P = 0.04), suggesting that their intervention of a senior-resident-led RRT decreased ICU transfers by intervening before patient deterioration, although for patients transferred to the ICU, they did not demonstrate a decrease in overall mortality or 30-day mortality. Conversely, Moriarty et al, 3 found an increase in ICU transfers from 13.7 to 15.2 per 1000 floor days ( P < 0.001) and hypothesized that this could be due to a larger number deteriorating patients being seen and transferred to the ICU appropriately by the RRT.…”

Section: Resultsmentioning

confidence: 98%

“…Studies that do acknowledge an activation process either analyze the impact of the event detection mechanism and the impact of the team response on patient outcomes separately 15 or analyze the impact of the RRS as a whole. 17 – 19 The actual mechanism of the activation process is often left undefined, without clear descriptions of who participates, what the process involves (including use of electronic monitoring systems), or whether activation is mandatory versus voluntary. One study included in the systematic review by Daniele et al 20 found that changing the activation mechanism from a voluntary to mandatory call based on physiologic criteria resulted in a statistically significant decrease in cardiopulmonary arrest rates.…”

Section: Discussionmentioning

confidence: 99%

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The Use of Rapid Response Teams to Reduce Failure to Rescue Events: A Systematic Review

2020

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Overview of the 100,000 Lives Campaign "The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been."

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Section: Resultsmentioning

confidence: 59%

Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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The Use of Rapid Response Teams to Reduce Failure to Rescue Events: A Systematic Review

2020

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“…Since the adoption of RRTs, hospitals have explored concerns over failure to identify and rescue patients early, delayed assessment or treatments, increased clinical handoffs to a team unfamiliar with the patient, and allocation of limited human and financial resources to support formal emergency teams. [1][2][3][4][5]7,8,10 Clinical deterioration may be preceded by hours of undetected warning signs and symptoms before a serious adverse event such as cardiopulmonary arrest. 2,10 Causes that can lead to failure to rescue include failure to recognize clinical changes, failure to communicate concerns, and failure of a timely response to treat the patient.…”

Section: Available Knowledgementioning

confidence: 99%

Using a Clinical Triggers System to Improve Early Recognition of Clinical Changes

Lee,

Leng,

Kerbel

2023

Clin Nurse Spec

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Purpose A medical-surgical telemetry unit implemented a clinical triggers system for early recognition of clinical deterioration and bedside management between nurses and providers. The goal was to decrease cardiopulmonary arrest events. Description of the Project A clinical triggers system was developed to help nurses to identify clinical markers early and advocate for prompt bedside assessment and interventions. When clinical triggers were identified, the nurse notified the provider, who performed a bedside assessment within 15 minutes. If the provider did not respond promptly, the rapid response team was activated. Outcomes Before intervention, the unit experienced 14 cardiopulmonary arrest events (rate of 1.37 per 1000 patient days). Incidences decreased annually to 5, 4, and 3 events (rates of 0.49, 0.39, and 0.3 per 1000 patient days) during the 3-year implementation period. Conclusions The clinical triggers system was successful in achieving the project objective of decreasing unit cardiopulmonary arrest events through early recognition and response to patient deterioration during the implementation period. The clinical nurse specialist helped nurses to use the clinical triggers system to detect and respond to clinical changes. Nurses were empowered to address concerns and promote patient safety.

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“…If these changes are detected early, unexpected deaths, serious adverse events or cardiac arrest can be prevented. Delays in ICU consultations for critically ill patients in medical wards have been associated with increased mortality 4…”

Section: Introductionmentioning

confidence: 99%

Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths

Swami,

Shams,

Mittelstadt

et al. 2023

BMJ Open Qual

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BackgroundEarly detection of patients with clinical deterioration admitted to the hospital is critical. The early warning system (EWS) is developed to identify early clinical deterioration. Using individual patient’s vital sign records, this bedside score can identify early clinical deterioration, triggering a communication algorithm between nurses and physicians, thereby facilitating early patient intervention. Although various models have been developed and implemented in emergency rooms and paediatric units, data remain sparse on the utility of the EWS in patients admitted to general internal medicine wards and the processes and challenges encountered during the implementation.Local problemThere is a lack of standardised tools to recognise early deterioration of patient condition.MethodsThis was a quality improvement project piloted in the clinical teaching unit of a tertiary care hospital. Data were collected 24 weeks pre-EWS and 55 weeks post-EWS implementation. A series of Plan, Do, Study, Act cycles were conducted to identify the root cause, develop a driver diagram to understand the drivers of unexpected deaths, run a sham test trial run of the EWS, educate and obtained feedback of clinical care teams involved, assess adherence to the EWS during the pilot project (6 weeks pre-EWS and 6 weeks post-EWS implementation), evaluate outcomes by extending the duration to 24 weeks pre-EWS and 55 weeks post-EWS implementation, and retrospectively review the uptake of the EWS.InterventionsImplementation of a standardised protocol to detect deterioration in patient condition.ResultsDuring the pre-EWS implementation phase (24 weeks), there were 4.4 events per week (1.2 septic workups, 1.9 observation unit transfers, 0.7 critical care transfers, 0.13 cardiac arrests and 0.46 per week unexpected deaths). In the post-EWS implementation phase (55 weeks), there were 4.2 events per week (1.0 septic workup, 1.9 observation unit transfers, 0.82 critical care transfers, 0.25 cardiac arrests and 0.25 unexpected deaths).ConclusionThe EWS can improve patient care; however, more engagement of stakeholders and electronic vital sign documentation may improve the uptake of the system.

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Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

Cited by 5 publications

References 22 publications

The Use of Rapid Response Teams to Reduce Failure to Rescue Events: A Systematic Review

The Use of Rapid Response Teams to Reduce Failure to Rescue Events: A Systematic Review

Using a Clinical Triggers System to Improve Early Recognition of Clinical Changes

Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths

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