Realistic Evaluation of a Rapid Response System: Context, Mechanisms, and Outcomes

Abstract

The purpose of this study was to describe and explore differences between rapid response system events in a Midwestern community hospital through context, mechanism, and outcome factors. The design was a retrospective review of 1,939 adult inpatient events that occurred on medical (62.8%) and surgical units (37.2%) over 92 months. The immediate outcomes of the events were stabilization (59.0%), transfer to a higher level of care (39%), and cardiopulmonary arrest (2%). Nurses activated 94% of all rapid response events; respiratory (38.8%) and cardiac (29.2%) symptoms were the most common triggers, and worry alone triggered 23% of all events. Medical and surgical events were significantly different with regard to antecedents to unit arrival, most common triggers, immediate clinical outcomes, and occurrence during resource-limited times. Understanding rapid response events and differences between medical and surgical units is important to improve early identification of deterioration and thus intervention for vulnerable patients.

Assessing the Usability of a Novel Wearable Remote Patient Monitoring Device for the Early Detection of In-Hospital Patient Deterioration: Observational Study

“…The analysis failed to reach firm conclusions owing to the low quality of design and subsequent outcomes of such studies. One potential cause could be the fact that in different clinical scenarios (eg, general wards vs surgical departments) the clinical circumstances, the classifications used to define the clinical deterioration, and the competencies of the clinical staff are heterogenous [2,3]. Therefore, ideally, early detection technologies and applied prediction algorithms should be tailored for specific patient populations and clinical scenarios.…”

Failure mode and effect analysis (FMEA) to identify and mitigate failures in a hospital rapid response system (RRS)

“…The literature on the RRS from New Zealand and elsewhere have mainly reported the epidemiology of RRS activations [2,3,4,5], outcomes of the in-hospital cardiac arrests [6,7,8] and comparison of various models of the RRS to recognise deteriorating patients in general hospital wards, outside critical care settings [9,10]. There is a severe shortage of literature on how the RRS could be improved using systems approaches.…”

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

“…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.…”

“…[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. 11 Missed or delayed response to clinical decline can contribute to increased length of stay, unplanned complications such as ICU admission, and increased morbidity and mortality.…”