Proceedings of the 12th International Conference on Rapid Response Systems and Medical Emergency Teams

Jones, Daryl; Holmes, J.; Currey, Judy; Fugaccia, Elizabeth; Psirides, Alex; Singh, Mandeep; Fennessy, GJ; Hillman, Kenneth; Pilcher, D.; Bellomo, Rinaldo; DeVita, Michael A.

doi:10.1177/0310057x1704500416

Cited by 8 publications

(4 citation statements)

References 3 publications

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“…Implementing a complex dynamic and inter-related intervention in a specialist healthcare environment is challenging. [11,[57][58][59] Guidance on developing, implementing, evaluating and publishing complex interventions are available [13,59], but there are few actual case studies of implementing complex interventions in healthcare and relating to early warning systems. [60,61] The early warning or rapid response literature has focused broadly on 'does the score/response team work' [1,2,3,8,10] and, more recently, attempts to understand why the score/response team appears to work in single-centre studies and not large multi-centre studies [3,10,25,56,62,63].…”

Section: Discussionmentioning

confidence: 99%

Quality Improvement Implementation and Maintenance of a Paediatric Early Warning System

Duncan¹,

Oliver²,

Emms³

et al. 2020

Preprint

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Background: Paediatric Early Warning (PEW) systems have led to earlier identification and escalation of treatment with subsequent admission to Paediatric Intensive Care (PIC) in deteriorating children. The impact on reductions in cardiac arrest and mortality vary between the heterogeneous studies, showing both unchanged and reduced cardiac arrest, morbidity and mortality. Identifying and managing critical illness on wards is a complex and dynamic process involving technology, human interaction, cultural context and environment. We introduced a PEW system to reduce potentially avoidable cardiac arrest and death.Methods: We report an Implementation Science Quality Improvement (QI) natural experiment using the Medical Research Councils (MRC) Guidelines for Developing and Evaluating Complex Interventions, Action Research, Action Research Theory and methods. The aim of this program was to identify learning, refinement and improvement opportunities to reduce poor outcomes. The interventions were 1) developing an observation and monitoring policy to standardise practice and provide a template for optimal care, 2) standardized charting with an embedded PEW score, 3) clinical skills training, 4) clinical process audit and feedback and 5) outcome surveillance.The process measures were 1) timeliness and impact for unplanned Paediatric Intensive Care (PIC) admissions, 2) clinical assessment skills and 3) chart completion compliance. The outcome measures included 4) total and predictable cardiac arrests and 5) hospital mortality. Data collection started in 2004, the PEW system was implemented in 2008, and the outcomes were reported through 2018.Results: In our specialist children’s hospital, we completed six improvement cycles over 10 years. 1) Timely PIC admissions improved after implementation (39% to 92%). Patients with unplanned PIC admissions had significantly lower severity of illness and mortality but a longer length of stay. 2) Routine clinical observation accuracy improved (66 to 82%) following multimodal training. 3) Chart completion compliance improved (87 to 99%). In 2018, 2% of observations had missing or inaccurate parameters with a consequent inaccurate total PEW score. 4) The total cardiac arrest rate was significantly reduced (0.36 to 0.16 per 1000 admissions). The small numbers of predictable cardiac arrests showed a decreasing trend. 5) Hospital mortality was significantly reduced (3.46 to 2.24 per 1000 admissions). Outcomes improved approximately 18 months after implementation and have not changed significantly since 2010 despite increasing critical care resources in and out of PIC. The impact of the PEW system on these outcomes is possible but not conclusive.Conclusion: Implementation of the PEW system as a complex intervention using QI methods is associated with improved clinical skill accuracy, chart compliance and detection of deterioration associated with more timely unplanned PIC admissions. These improvements were associated with a significant reduction in cardiac arrest and mortality.

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Section: Discussionmentioning

confidence: 99%

Quality Improvement Implementation and Maintenance of a Paediatric Early Warning System

Duncan¹,

Oliver²,

Emms³

et al. 2020

Preprint

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“…Critical care specialists extended this approach to improve in-hospital CPR through the development of in-hospital CA registries including the American Heart Association's Get With The Guidelines-Resuscitation and SCCM's "Project IMPACT" to evaluate the effectiveness of in-hospital CPR and potential opportunities for quality improvement (27)(28)(29)(30)(31). We learned that in-hospital CAs were heralded by hours of potentially actionable early warning signs, sparking the development of rapid response teams (also known as medical emergency teams) to prevent CAs (32,33); time to defibrillation was a major determinant of survival from in-hospital VF CAs and defibrillation was delayed for greater than 3 minutes in 30% of arrests (35); survival outcomes were worse for nighttime and weekend CAs compared with daytime and weekday arrests (34); CA outcomes varied greatly among hospitals (35); avoiding interruptions in chest compressions (36) is associated with improved outcomes; and extracorporeal membrane oxygenation-assisted CPR (ECPR) can be life-saving for highly selected populations (37)(38)(39)(40)(41).…”

Section: Intertwined History Of Sccm and Cpr Over The Last Half Centurymentioning

confidence: 99%

Cardiopulmonary Resuscitation and Rescue Therapies

Dalton

Berg

Kochanek³

et al. 2021

Critical Care Medicine

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“…Rapid response teams have been introduced into hospitals worldwide in an effort to improve the outcomes of deteriorating hospitalized patients. 52 There is considerable variability in the makeup of rapid response teams, which often include physician extenders, such as nurses and RTs, especially in the United States. The overall impact of rapid response teams on patient outcomes has been mixed with a call for more comprehensive research in this area.…”

Section: Rts and Rapid Response Teamsmentioning

confidence: 99%

Evaluating the Value of the Respiratory Therapist: Where Is the Evidence? Focus on the Barnes-Jewish Hospital Experience

Kollef

2017

Respir Care

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Currently, >20 million people in the United States have asthma, and approximately 15 million adults have been diagnosed with COPD, with approximately the same number not yet having been diagnosed with this condition. Moreover, the overall burden of respiratory diseases is still increasing, in part due to environmental factors, such as air pollution. At the same time, the number of patients requiring hospitalization as well as the number of individuals admitted to ICUs from emergency departments has been on the rise over the last decade. Because of the cost to the health-care system, the burden of respiratory diseases, hospitalizations, and ICU admissions also falls on society; it is paid for with tax dollars, higher health insurance rates, and lost productivity. Respiratory therapists (RTs) are in a unique position to influence health-care delivery in a number of settings that include acutely ill hospitalized patients and those with chronic conditions in ambulatory settings. Clinical studies have demonstrated the value of RTs in specific areas, including the performance of medical procedures, the development and implementation of protocols aimed at weaning patients from mechanical ventilation and providing lung-protective ventilation, optimal delivery of in-patient respiratory treatments, the application of disease management programs for COPD, and as part of rapid response teams. However, due to increasing scrutiny of health-care expenditures and limited resources, there is a growing need to document the impact of health-care providers in terms of clinical outcomes. As a profession, RTs should continue to describe the impact they have on patient outcomes and the value they bring to our health-care system. Promoting such investigative outcomes research, along with enhancing the professional aspects of the field of respiratory care, will ensure that the value of RTs does not go unappreciated.

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Proceedings of the 12th International Conference on Rapid Response Systems and Medical Emergency Teams

Cited by 8 publications

References 3 publications

Quality Improvement Implementation and Maintenance of a Paediatric Early Warning System

Quality Improvement Implementation and Maintenance of a Paediatric Early Warning System

Cardiopulmonary Resuscitation and Rescue Therapies

Evaluating the Value of the Respiratory Therapist: Where Is the Evidence? Focus on the Barnes-Jewish Hospital Experience

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