Outcomes following changing from a two-tiered to a three-tiered hospital rapid response system

2019 ◽  
Vol 43 (2) ◽  
pp. 178
Author(s):  
The Concord Medical Emergency Team Study Investigators
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Structured Interviews ◽  
Emergency Team ◽  
Response System

Objectives The aim of the present study was to determine whether changing a hospital rapid response system (RRS) from a two-tiered to a three-tiered model can reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. Methods Staff at an Australian teaching hospital attending medical emergency team and cardiac arrest (MET/CA) calls were interviewed after the RRS was changed from a two-tiered to three-tiered model, and the results were compared with a study using the same methods conducted before the change. The main outcome measures were changes in: (1) the incident rate resulting from staff leaving normal duties to attend MET/CA calls; (2) the cardiac arrest rate, (3) unplanned intensive care unit (ICU) admission rates; and (4) hospital mortality. Results We completed 1337 structured interviews (overall response rate 65.2%). The rate of incidents occurring as a result of staff leaving normal duties to attend MET/CA calls fell from 213.7 to 161.3 incidents per 1000 MET/CA call participant attendances (P<0.001), but the rate of cardiac arrest and unplanned ICU admissions did not change significantly. Hospital mortality was confounded by the opening of a new palliative care ward. Conclusion A three-tiered RRS may reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. What is known about the topic? RRS calls result in significant disruption to normal hospital routines because staff can be called away from normal duties to attend. The best staffing model for an RRS is currently unknown. What does this paper add? The present study demonstrates, for the first time, that changing a hospital RRS from a two-tiered to a three-tiered model can reduce the rate of incidents reported by staff caused by leaving normal duties to attend RRS calls while maintaining the same overall patient outcomes. What are the implications for practitioners? Hospitals could potentially reduce disruption to normal hospital routines, without compromising patient care, by changing to a three-tiered RRS.

scholarly journals Improving rapid response system performance in a Chinese Joint Commission International Hospital

2019 ◽  
Vol 47 (7) ◽  
pp. 2961-2969
Author(s):  
Minfei Yang ◽  
Lanlan Zhang ◽  
Yuwei Wang ◽  
Yue Zhan ◽  
Xiaofei Zhang ◽  
...  
Keyword(s):  
Medical Emergency Team ◽  
Joint Commission ◽  
Rapid Response ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Serious Adverse Events ◽  
Emergency Team ◽  
Response System ◽  
Joint Commission International ◽  
The Impact

Objective To assess the impact of a regional rapid response system (RRS) implemented in a Chinese Joint Commission International Hospital on the timely treatment of patients with serious adverse events (SAEs). Methods Clinical SAEs, activation periods, reasons for RSS activation, and patient outcomes were assessed using SAE response sheets at admission to the hospital and over 31 months of follow-up. Results We found that 192 events were called by medical staff and 6 were called by auxiliary staff. Reasons for the 385 RRS activations included: unconsciousness (133; 34.5%), and airway obstruction and absent carotid pulse (49 each; 12.7%). The average arrival time of the medical emergency team was 2.4 ± 0.1 minutes. There were 123 (62.1%) RRS activations during daytime working hours (8:00–17:00); CPR was performed in 86 (43.4%) cases. Outcomes of RRS were: vital signs stabilized in 82 (41.4%) patients and 61 (30.8%) patients were transferred to ICU. Conclusion Our experience showed that the regional RRS has led to better integrated multidisciplinary cooperation and reduced time for treating patients with SAEs, resulting in success of the RRS.

A ten year check-up for a rapid response system—Revitalizing our medical emergency team

2011 ◽  
Vol 24 (1) ◽  
pp. 72
Author(s):  
N. Pratt ◽  
J. Molloy ◽  
J. Botha ◽  
T. Tobias ◽  
S. White ◽  
...  
Keyword(s):  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Emergency Team ◽  
Response System

scholarly journals Effect of implementation of a rapid response system on protocol adherence in a surgical ward

2013 ◽  
Vol 3 (3) ◽  
pp. 23
Author(s):  
Friede Simmes ◽  
Lisette Schoonhoven ◽  
Joke Mintjes ◽  
Bernard G. Fikkers ◽  
Johannes G. van der Hoeven
Keyword(s):  
Medical Records ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
University Hospital ◽  
Early Warning Score ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Emergency Team ◽  
Response System ◽  
Surgical Ward

Objective: To describe the implementation of a rapid response system and adherence to its afferent limb in order to identify key elements for improvement. Implementation: We developed a multifaceted implementation strategy to introduce the Rapid Response System (RRS) on a 60-bed surgical ward of a university hospital. The strategy included the use of clear objectives, key leaders, an early warning score (EWS) observation protocol and a two-tiered medical emergency team (MET) warning protocol, a 1-day training program including a before-after knowledge test, mandatory for nurses and optional for ward physicians, reminders and feedback. Study design and methods: We retrospectively analyzed a sample of 10,653 patient days and 101 medical records of patients with a serious adverse event (SAE). Outcome measures were EWS recording rates, the nurse to ward physician and the ward physician to the MET calling rates following abnormal EWS recordings, and the indicators triggering these calls. Results: EWS recordings were present in 90% of the day shifts, 88% of the evening shifts and 80% of the night shifts. EWSs were recorded at least once in 92/101 medical records in the three days before an SAE; in 91/101 records EWSs were abnormal at least once. In case of an abnormal score, the nurse called the ward physician once or more in 87% (79/91). After being called by the nurse, the ward physician called the MET once or more in 75% (59/79). However, in 18% (15/79) there was a delay of one or two days before the ward physician/MET was called. Overall, medical emergency team calls were absent or delayed in over 50%. Conclusions: After RRS implementation, recording of the EWS was high. Adequate warning in case of abnormal scores was suboptimal in nurses as well as ward physicians. Future implementation strategies should therefore be aimed at the interdisciplinary team.

scholarly journals A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258221
Author(s):  
Su Yeon Lee ◽  
Jee Hwan Ahn ◽  
Byung Ju Kang ◽  
Kyeongman Jeon ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Arterial Line ◽  
Screening System ◽  
Emergency Team ◽  
Line Insertion ◽  
Icu Transfer ◽  
Portable Ultrasonography

Background According to the rapid response system’s team composition, responding teams were named as rapid response team (RRT), medical emergency team (MET), and critical care outreach. A RRT is often a nurse-led team, whereas a MET is a physician-led team that mainly plays the role of an efferent limb. As few multicenter studies have focused on physician-led METs, we comprehensively analyzed cases for which physician-led METs were activated. Methods We retrospectively analyzed cases for which METs were activated. The study population consisted of subjects over 18 years of age who were admitted in the general ward from January 2016 to December 2017 in 9 tertiary teaching hospitals in Korea. The data on subjects’ characteristics, activation causes, activation methods, performed interventions, in-hospital mortality, and intensive care unit (ICU) transfer after MET activation were collected and analyzed. Results In this study, 12,767 cases were analyzed, excluding those without in-hospital mortality data. The subjects’ median age was 67 years, and 70.4% of them were admitted to the medical department. The most common cause of MET activation was respiratory distress (35.1%), followed by shock (11.8%), and the most common underlying disease was solid cancer (39%). In 7,561 subjects (59.2%), the MET was activated using the screening system. The commonly performed procedures were arterial line insertion (17.9%), intubation (13.3%), and portable ultrasonography (13.0%). Subsequently, 29.4% of the subjects were transferred to the ICU, and 27.2% died during hospitalization. Conclusions This physician-led MET cohort showed relatively high rates of intervention, including arterial line insertion and portable ultrasonography, and low ICU transfer rates. We presume that MET detects deteriorating patients earlier using a screening system and begins ICU-level management at the patient’s bedside without delay, eventually preventing the patient’s condition from worsening and transfer to the ICU.

Abstract 034: Rapid Response Activation and In-hospital Mortality

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Kinan Kassar ◽  
Dorothy Pusateri ◽  
Anastasios Kapetanos
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Respiratory Distress ◽  
Mental Status ◽  
Medical Emergency Team ◽  
Patient Characteristics ◽  
Rapid Response ◽  
Medical Emergency ◽  
Emergency Team ◽  
Healthcare Improvement

Introduction: The institute for Healthcare Improvement (IHI) encouraged the implementation of rapid response teams (RRT) in hospitals with the aim of early detection of patient deterioration. The rapid response system (formerly Medical Emergency Team (MET)) has been in place at our institution since 2005; however, data regarding its utilization and outcomes are scarce. Methods: Data regarding patient characteristics and reasons for activating RRTs were collected from hospital telephone operator records and patient medical records. The study was IRB exempt. Results: During a 2 month period (08/09/16 to 10/09/16), the RRT was activated 96 times on 93 patients. Of those, 31 RRT activations (32%) took place within 24 hours of admission to the hospital. The average age of these patients was 64, and 59% were male. Fifty-four RRT activations (56%) were called during the daytime shift (from 7 am to 7 pm). The reason for calling the RRT was mentioned in the hospital operators paging message in 67/96 cases. The most common reasons for activating the system were: Respiratory distress 34/67 (51%), mental status changes 9/67 (13%), and tachycardia 9/67 (13%). Other less common causes were seizures 3/67 (4.5%), chest pain 3/67 (4.5%), hypotension 3/67 (4.5%), and falls 2/67 (3%). Twenty patients (22%) on whom an RRT was called, died during the same hospital admission. The mortality rate of those patients was 6 folds higher than the general In-hospital mortality rate. The average age of the patients who died was 63. Respiratory distress was the most common cause of RRT activation among patients who died 10/20 (50%). Conclusion: Patients admitted to the hospital who had an RRT activation had a six fold risk of dying during the same admission. The majority of RRT activations were for respiratory distress, mental status changes, and tachycardia, and one-third occurred within the first 24 hours of admission. Routine review of RRT data can help target areas for improvement, specifically, factors contributing to in-hospital mortality.

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