Original Research: The Role of the Non-ICU Staff Nurse on a Medical Emergency Team: Perceptions and Understanding

Pusateri, Margaret; Prior, Michele M.; Kiely, Sharon

doi:10.1097/01.naj.0000398045.00299.64

Cited by 16 publications

(14 citation statements)

References 22 publications

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“…26 Even receiving criticism from the arriving MET team that the patient was not sufficiently unwell has been cited by nurses as a barrier to activation. 27 …”

Section: Discussionmentioning

confidence: 99%

Temporal distribution of instability events in continuously monitored step-down unit patients: Implications for Rapid Response Systems

et al. 2015

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AIM Medical Emergency Teams (MET) activations are more frequent during daytime and weekdays, but whether due to greater patient instability, proximity from admission time, or caregiver concentration is unclear. We sought to determine if instability events, when they occurred, varied in their temporal distribution. METHODS Monitoring data were recorded (frequency 1/20Hz) in 634 SDU patients (41,635 monitoring hours). Vital sign excursion beyond our MET trigger thresholds defined alerts. The resultant 1,399 alerts from 216 patients were tallied according to clock hour and time elapsed since admission. We fit patient ID (n=216), clock hour, time since SDU admission, and alert present into a null model and three mixed effect logistic regression models: clock hour, hours elapsed since admission, and both clock hour and time elapsed since admission as fixed effect covariates. We performed likelihood ratio tests on these models to assess if, among all alerts, there were proportionally more alerts for any given clock hour, or proximity to admission time. RESULTS Only time elapsed since admission (p<0.001), and not clock hour adjusting for time elapsed since admission (p=0.885), was significant for temporal disproportion. Results were unchanged if the first 24 hours following admission were excluded from the models. CONCLUSION Although instability alerts are distributed most frequently within 24 hours after SDU admission in unstable patients, they are otherwise not more likely to distribute proportionally more frequently during certain clock hours. If MET utilization peaks do not coincide with admission time peaks, other variables contributing to unrecognized instability should be explored.

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“…26 Even receiving criticism from the arriving MET team that the patient was not sufficiently unwell has been cited by nurses as a barrier to activation. 27 …”

Section: Discussionmentioning

confidence: 99%

Temporal distribution of instability events in continuously monitored step-down unit patients: Implications for Rapid Response Systems

et al. 2015

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“…Each study developed a new local survey tool to address specific study aims except one, which used a locally modified version of a previously developed tool (Beebe et al., ). Only four referenced other work to inform the development or administration of the instrument (McIntyre et al., ; Pusateri, Prior, & Kiely, ; Rotella, Yu, Ferguson, & Jones, ; Stevens et al., ). While all studies reported that the newly developed surveys had pretesting prior to distribution, none provided any convincing evidence of instrument reliability or validity.…”

Section: Quality Appraisal Of Study Methodsmentioning

confidence: 99%

“…Three studies provided clear justification for sample size calculations (Plowright et al., ; Sarani et al., ; Stevens et al., ), and four described representativeness of the sample (Jones et al., ; Pusateri et al., ; Sarani et al., ; Stevens et al., ), and the population sampling frame (Jones et al., ; Rotella et al., ; Sarani et al., ; Stevens et al., ). Ethics approval was noted in every study, with three exempted as local quality improvement surveys (Plowright et al., ; Salamonson et al., ; Stevens et al., ).…”

Section: Quality Appraisal Of Study Methodsmentioning

confidence: 99%

“…Ethics approval was noted in every study, with three exempted as local quality improvement surveys (Plowright et al., ; Salamonson et al., ; Stevens et al., ). Of note, five did not explicitly comment on participant consenting procedures (Jones et al., ; Plowright et al., ; Pusateri et al., ; Sarani et al., ; Stevens et al., ).…”

Section: Quality Appraisal Of Study Methodsmentioning

confidence: 99%

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Recognising and responding to in‐hospital clinical deterioration: An integrative review of interprofessional practice issues

Allen

Elliott

Jackson

2017

Journal of Clinical Nursing

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“…However, a RRS suffers from the lack of integration in hospitals. A by the nurses are the discouragement by the doctors, the fear of being subjected to criticism, and the adherence to models that lead to contact the ward doctors before activating the MET system [104,105]. An Italian multicenter survey [106] involved doctors and nurses, in a group of 10 hospitals; findings of the study showed that, for the nurses, the ward doctors were the main obstacle to MET activation.…”

Section: Evaluating the Type Of Interventionmentioning

confidence: 99%

Rapid Response Systems: how to interpret levels of evidence

Difonzo

2017

CMI

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Clinical management abstractBACKGROUND AND AIM: The Rapid Response System (RRS) has been introduced to prevent cardiac arrest, unplanned admissions to the intensive care unit, and death in hospitalized patients. Despite the constant and widespread presence of this system in worldwide hospitals, it remains debated whether its use improves patient outcomes. The aim of this narrative review is to describe the available evidence supporting the effectiveness of RRSs and to discuss the controversies on the lack of level 1 evidence studies. METHODS: The literature search covers the period from 1 January 2000 to 31 March 2016. RESULTS: Studies with different research designs, observational, quasi-experimental with non-randomized control group and experimental, and aggregate data of meta-analyses indicate a statistically significant reduction of in-hospital cardiac arrests and hospital mortality associated with the deployment of RRSs. CONCLUSIONS: A RRS is a complex intervention in a complex system, such as a hospital. This complexity does not allow considering experimental trials only as the most appropriate methodology to answer at research objectives. Furthermore, the benefits of a RRS depend greatly on its proper use. Accumulating evidence suggests the importance to investigate barriers and facilitators that can affect the integration, within a hospital, of this complex intervention.

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Original Research: The Role of the Non-ICU Staff Nurse on a Medical Emergency Team: Perceptions and Understanding

Abstract: bedside nurse, medical emergency team, non-ICU staff nurse, nurse attitudes, patient crisis, patient safety, rapid response system, survey.

Cited by 16 publications

References 22 publications

Temporal distribution of instability events in continuously monitored step-down unit patients: Implications for Rapid Response Systems

Temporal distribution of instability events in continuously monitored step-down unit patients: Implications for Rapid Response Systems

Recognising and responding to in‐hospital clinical deterioration: An integrative review of interprofessional practice issues

Rapid Response Systems: how to interpret levels of evidence

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