Rapid response systems

Lyons, Patrick G.; Edelson, Dana P.; Churpek, Matthew M.

doi:10.1016/j.resuscitation.2018.05.013

Cited by 133 publications

(118 citation statements)

References 102 publications

(149 reference statements)

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Section: Rapid Response Systemsmentioning

confidence: 99%

“…These monitoring and escalation behaviours are typically performed by nursing staff (Smith & Aitken, 2016). The efferent limb of the RRS includes all actions that follow escalation performed by the responder/s (Lyons et al, 2018). Efferent limb behaviours include performing additional patient assessment, initiating treatment or stabilising interventions, and facilitating a transfer of the patient to a higher-care setting, for example, a critical care unit (Bannard-Smith et al, 2016).…”

Section: Rapid Response Systemsmentioning

confidence: 99%

“…To facilitate a timely and clinically appropriate response to patient deterioration, healthcare organisations globally have implemented rapid response systems (RRS) (Lyons, Edelson, & Churpek, ). Despite differences in how these services have been operationalised, the characteristics are often similar.…”

Section: Introductionmentioning

confidence: 99%

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How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

Smith

Sekhon

Francis

et al. 2019

Journal of Clinical Nursing

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Background To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an “afferent” and “efferent” limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust‐level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. Aim To identify how deteriorating patient policy documents provide “actionable” behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. Design A structured content analysis of a national guideline and local policies using a behaviour specification framework. Methods Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. Results There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). Conclusion Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. Relevance to clinical practice Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time‐sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.

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Section: Rapid Response Systemsmentioning

confidence: 99%

Section: Rapid Response Systemsmentioning

confidence: 99%

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How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

Smith

Sekhon

Francis

et al. 2019

Journal of Clinical Nursing

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“…Unexpected cardiac arrest in the hospital occurred in various places including the intensive care unit and it was found that the survival discharge rate is low both in Japan and other countries [35,36]. To improve those situations, an emergency medical team capable of implementing rapid CPR and a rapid response team capable of determining severity beforehand are required [37]. Cardiovascular and intensive care physicians need to promote the medical team and training of the corresponding team is also necessary [38,39].…”

Section: Patient Safety and Prevention Of Out-of-hospital And In-hospmentioning

confidence: 99%

The necessity of conversion from coronary care unit to the cardiovascular intensive care unit required for cardiologists

Nonogi

2019

Journal of Cardiology

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“…EWS is part of a rapid response system. A rapid response system consists of an afferent limb with staff measuring vital parameters and calculating a score, and an efferent limb consisting of an algorithm to trigger a call for a physician or medical emergency team [4].…”

Section: Introductionmentioning

confidence: 99%

Including oxygen supplement in the early warning score: a prediction study comparing TOKS, modified TOKS and NEWS in a cohort of emergency patients

Skov

Dynesen

Jessen

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Early warning scores (EWS) are widely used in emergency departments and on general wards to detect critical illness and deterioration. TOKS ("Tidlig Opsporing af Kritisk Sygdom") is an early warning score used in Central Denmark Region to monitor hospitalized patients. The objective of this study is to investigate whether inclusion of supplement in the TOKS algorithm (modified TOKS; mTOKS), would improve the ability to predict 7-day mortality. Secondarily, we compare the discriminatory ability between TOKS, mTOKS and the National Early Warning Score (NEWS). Methods: This is a prediction study including a cohort of adult patients who attended an emergency department in Central Denmark Region during a 3-month period in 2015. The discriminatory ability of TOKS, mTOKS and NEWS was evaluated by calculating the area under the receiver operating characteristics-curve (AUROC) with 7-day mortality as outcome. mTOKS was defined by adding 2 points for oxygen supplement to the normal TOKS score. Results: 18.853 patients were included. AUROC for TOKS: 0,78 (95%-CI: 0,76-0,81). AUROC for mTOKS: 0,81 (95 %-CI: 0,78-0,83). AUROC for NEWS: 0,83 (95%-CI: 0,80-0,85). The predictive ability of all three early warning scores are statistically significantly different from each other (p-value < 0,01). Conclusion: The discriminatory ability of TOKS improved statistically by including oxygen supplement. All models showed moderate to good discriminatory ability.

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Rapid response systems

Cited by 133 publications

References 102 publications

How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

The necessity of conversion from coronary care unit to the cardiovascular intensive care unit required for cardiologists

Including oxygen supplement in the early warning score: a prediction study comparing TOKS, modified TOKS and NEWS in a cohort of emergency patients

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