Use of the pre-medical emergency team tier of rapid response systems: A scoping Review

Sprogis, Stephanie K; Currey, Judy; Jones, Daryl; Considine, Julie

doi:10.1016/j.iccn.2021.103041

Cited by 20 publications

(20 citation statements)

References 55 publications

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“…Oversensitivity of the call criteria leading to inappropriate early triggering of MET was also found (Grant & Crimmons, 2018). (Sprogis et al, 2021) highlighted that while 'It is usually intended that pre-MET events culminate in medically-led pre-MET reviews… initial management within a nursing scope may constitute safe and reasonable responses to many pre-MET events.' One possible solution to problems experienced when deterioration was noticed before 'clinical review' (see Figure 1) could be the introduction of nurse-initiated interventions known as 'standing orders'.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…There is tension between the requirement of RNs to follow the escalation protocol and their desire to exercise clinical judgement in the management of specific situations, prior to involvement of the Medical Emergency Team (MET). (Sprogis et al, 2021) pointed to the challenges met by nurses when seeking pre‐MET reviews from doctors responsible for patients’ clinical management on the wards. Specifically, this situation occurs when there is a lengthy time interval prior to medical review and the opportunity to stabilise the patient and prevent further deterioration is lost.…”

Section: Introductionmentioning

confidence: 99%

“…(Sprogis et al, 2021) highlighted that while ‘It is usually intended that pre‐MET events culminate in medically‐led pre‐ MET reviews…initial management within a nursing scope may constitute safe and reasonable responses to many pre‐MET events.’ One possible solution to problems experienced when deterioration was noticed before ‘clinical review’ (see Figure 1) could be the introduction of nurse‐initiated interventions known as ‘standing orders’. Standing orders have been defined in family practice as ‘written protocols that authorise designated members of the health care team (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Could standing orders have a place? A phenomenological exploration of experienced ward‐based registered nurses' views on the escalation protocol for patient deterioration

Minyaev

Harrington

King

2021

Journal of Clinical Nursing

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Aims and objectives To explore experienced ward‐based Registered Nurses’ views on the potential use of standing orders, prior to the escalation protocol, for patient deterioration. Background Ward based nurses are required to follow set steps of the escalation protocol. The introduction of standing order policies would allow nurses to intervene earlier when deterioration was first detected. Design Hermeneutic Phenomenology. Methods Ten experienced ward‐based RNs were recruited. Semi‐structured interviews were conducted, with the data subjected to thematic analysis. Diekelmann's framework was used to analyse the texts, seeking the highest level of hermeneutic analysis namely, a constitutive pattern. COREQ guidelines were utilised. Results Four main themes emerged: (1) Ambiguity in perception: the escalation protocol; (2) Observations within acceptable parameters, but the patient is deteriorating; (3) Paradoxes of escalation: well laid out protocol, but hard to escalate; (4) We could intervene with standing orders, but are we permitted? The constitutive pattern namely, Dualism in Perception related to the dissonance conveyed by participants regarding the escalation protocol. Conclusions Notwithstanding the benefits of the escalation protocol for junior staff, the RNs offered critique of the established escalation practices and the restrictive role of the protocol. Another aspect of the protocol, that is ‘worried criterion’ was viewed positively. The participants expressed a desire to apply nurse‐driven standing orders, to enable them to intervene earlier for patient deterioration. Relevance to clinical practice Organisations should consider new policies introducing standing orders for implementation by experienced RNs. The engagement of experienced ward‐based nurses in forming ‘patient at‐risk teams’ could assist organisations to deal with cases of clinical deterioration prior to activation of the escalation of care protocol.

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Section: Backg Rou N Dmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Could standing orders have a place? A phenomenological exploration of experienced ward‐based registered nurses' views on the escalation protocol for patient deterioration

Minyaev

Harrington

King

2021

Journal of Clinical Nursing

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“…Proactive rounding or a pre-MET tier of RRS that is combined with AI holds promise for safety and staffing solutions. Understanding gaps in processes, clinical practice, escalation protocols, and clinical interventions can be used to target strategies for improvement (Sprogis et al, 2021). Flexible staffing using remote surveillance has been used for consistent and timely patient care review.…”

Section: Introductionmentioning

confidence: 99%

A Patient Safety Solution: Evaluation of a 24/7 Nurse-led Proactive Rapid Response Program

Winterbottom

Webre²,

Gaudet³

et al. 2022

IJCC

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Background: Rapid Response Systems are patient safety programs that have been implemented around the world to reduce preventable patient harm and failure to rescue. Problem: There was a high rate of cardiac arrests outside the intensive care unit and absence of a structured system to identify and rescue patients with signs of clinical deterioration prior to cardiac arrest. Objectives: To evaluate the impact of a structured 24/7 nurse-led proactive rapid response program on clinical deterioration and cardio-pulmonary arrests. Methods: This study took place in a 650-bed quaternary academic regional referral center. The study period was between January 2014 and February 2020. A rapid response system redesign was initiated in early 2017 and a 24/7 nurse-led proactive rapid response program launched in December 2017. Results: A statistically significant decrease in rates of critical care cardio-pulmonary arrests, non-critical care cardio-pulmonary arrests, rapid response consults, unplanned ICU transfers, and hospital deaths occurred following implementation of the 24/7 nurse-led proactive rapid response program. Conclusions: Implementation of a structured 24/7 nurse-led rapid response program can decrease cardio-pulmonary arrests, unplanned transfers to ICU, and hospital deaths.

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“…13 There is a limited understanding of the characteristics and outcomes of patients who have pre-MET triggers, and the types of clinical interventions provided. 17 Greater understanding of pre-MET reviews is vital to support policy makers and clinicians to tailor pre-MET strategies to their intended patient cohorts and to inform future risk management strategies.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of patients receiving review requests for pre-medical emergency team deterioration: a cohort study

et al. 2021

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Objective. The aim of this study was to describe the epidemiology of pre-medical emergency team (pre-MET) reviews, including patient characteristics, the frequency and nature of triggers and interventions and in-hospital outcomes.Methods. An exploratory retrospective cohort study was performed using a medical record audit. Fifty orthopaedic and general medicine patients at a hospital in Melbourne, Australia, with requests for pre-MET reviews in 2016 were included. Descriptive analyses were performed.Results. The median patient age was 80 years (interquartile range 19 years). Most patients were female (64%), general medical patients (82%), with limitation of medical treatment orders (52%) and modified pre-MET triggers (42%). Documented pre-MET reviews occurred for 68% of requests. Tachypnoea (24%) and staff worry (24%) were the most common pre-MET triggers. One-third of patients received two clinical interventions. One in five patients had repeat requests for a pre-MET review within 12 h. In-hospital mortality was 12%.Conclusions. Most requests for pre-MET reviews related to older female patients. Clinician adherence to pre-MET policy was variable. Multicentre studies are needed to inform improvements to pre-MET strategies.What is known about the topic? Australian hospitals have introduced multi-tiered rapid response systems (RRSs) that consist of pre-MET review to comply with accreditation standards. Pre-MET reviews are triggered by early signs of clinical deterioration and are provided by admitting medical teams or senior nurses. There is limited understanding of the characteristics and outcomes of patients receiving pre-MET reviews for early clinical deterioration. What does this paper add? In a cohort of orthopaedic and general medicine patients, most patients receiving requests for pre-MET reviews were older, female medical patients, with existing modifications to pre-MET triggers. Most requests for pre-MET review were for tachypnoea or staff worry; the latter included clinical problems not addressed by predefined organisational triggers. One in five patients continued to deteriorate within 12 h of the pre-MET request. Clinician adherence to pre-MET policy varied.

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Use of the pre-medical emergency team tier of rapid response systems: A scoping Review

Cited by 20 publications

References 55 publications

Could standing orders have a place? A phenomenological exploration of experienced ward‐based registered nurses' views on the escalation protocol for patient deterioration

Could standing orders have a place? A phenomenological exploration of experienced ward‐based registered nurses' views on the escalation protocol for patient deterioration

A Patient Safety Solution: Evaluation of a 24/7 Nurse-led Proactive Rapid Response Program

Characteristics and outcomes of patients receiving review requests for pre-medical emergency team deterioration: a cohort study

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