scholarly journals Governance of Rapid Response Teams in Australia and New Zealand

2018 ◽  
Vol 46 (3) ◽  
pp. 304-309 ◽  
Author(s):  
S. S. Sethi ◽  
R. Chalwin
Keyword(s):  
New Zealand ◽  
Life Support ◽  
Advanced Life Support ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Public Hospitals ◽  
National Standard ◽  
Local Network ◽  
Public And Private ◽  
Benchmark Assessment

Rapid response systems (RRS) in hospitals in Australia and New Zealand (ANZ) have been present for more than 20 years but governance of the efferent limb—the rapid response team (RRT)—has not been previously reported in detail. The objectives of this study were to describe current governance arrangements for RRTs within ANZ and contrast those against expected implementation, using the Australian Commission for Safety and Quality in Health Care National Standard 9 (S9) as a benchmark. Assessment focused on S9 subclauses 9.1.1 (governance and oversight), 9.1.2 (RRT implementation), 9.2.3 (data collection and dissemination), 9.2.4 (quality improvement), 9.5.2 (call reviews), 9.6.1 and 9.6.2 (basic and advanced life support [ALS] skill set). We identified public and private hospitals across ANZ from government-maintained registers. Those reasonably expected to have an RRT were contacted and invited to participate. Responses were obtained via an online anonymised questionnaire. Three hundred and forty-two hospitals were contacted, of whom 284 (83.0%) responded. Two hundred and thirty-two hospitals submitted data, and the other 52 declined to participate or did not have an RRT. In hospitals with an intensive care unit (ICU), intensivist attendance at RRT calls occurred less often outside office hours (odds ratio, OR, 0.49, 95% confidence interval, CI, 0.32 to 0.75]). Where intensivists were not on the RRT, consultation with them about calls also occurred less often outside office hours (OR 0.39, 95% CI 0.22 to 0.66). Consultation with patients’ admitting specialists occurred more often during office hours versus out of hours RRT calls and in private versus public hospitals. The presence of ICU staff on the RRT decreased the likelihood of admitting specialists being consulted about RRT calls (OR 0.66, 95% CI 0.47 to 0.93). Most hospitals maintained databases of RRT calls and regularly audited RRT activity (92% and 90% respectively). However, most (63.7%) did not make that information available beyond their hospital or local network. We concluded that the majority of hospitals in the ANZ region had governance mechanisms for their RRT. However, there was a notable lack of consistency, especially around specialist involvement and audit processes. Although some findings from this study are reassuring, there is still potential for improvement. Further development of guidelines and the establishment of a regional RRS database may assist with achieving this.

scholarly journals New Zealand paramedics are ready for an autonomous pre-hospital thrombolysis protocol

2017 ◽  
Vol 14 (3) ◽  
Author(s):  
Paul Davis ◽  
Graham Howie ◽  
Bridget Dicker
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Clinical Decision Making ◽  
Life Support ◽  
Advanced Life Support ◽  
Clinical Decision ◽  
Multiple Choice Questions ◽  
Common Error ◽  
Paramedic Education ◽  
Written Test

IntroductionInternationally, autonomous paramedic-delivered pre-hospital thrombolysis (PHT) administration for ST-elevation myocardial infarction patients has proven to be a highly effective strategy in facilitating expedited delivery of this treatment modality. However, current New Zealand models rely on physician authorised telemetry-based systems which have proved problematic, particularly due to technological failings. The aim of this study is to establish whether current paramedic education in New Zealand is sufficient for the introduction of an autonomous paramedic clinical decision-making model of PHT.MethodsA one-hour workshop introduced a new PHT protocol to 81 self-selected paramedic participants – both rural and metropolitan based – from New Zealand. Paramedics were then tested in protocol application through completion of a scenario-based standardised written test. Four written scenarios constructed from actual field cases assessed 12-lead electrocardiogram interpretation, understanding of protocol inclusion/exclusion criteria, and treatment rationale. Ten multiple-choice questions further tested cardiac and pharmacology knowledge as well as protocol application.Results Overall clinical decision-making showed a sensitivity of 92.0% (95% CI: 84.8–96.5), and a specificity of 95.6% (95% CI: 89.1–98.8). Electrocardiogram misinterpretation was the most common error. University educated paramedics (n=44) were significantly better at clinical decision-making than in-house industry trained paramedics (n=37) (p=0.001), as were advanced life support paramedics (n=36) compared to paramedics of lesser practice levels (n=45) (p=0.006).Conclusion Our New Zealand paramedic sample demonstrated an overall clinical decision-making capacity sufficient to support the introduction of a new autonomous paramedic PHT protocol. Recent changes in paramedic education toward university degree programs are supported.

A review of rapid response team activation parameters in New Zealand hospitals

Resuscitation ◽  
2013 ◽  
Vol 84 (8) ◽  
pp. 1040-1044 ◽  
Author(s):  
Alex Psirides ◽  
Jennifer Hill ◽  
Sally Hurford
Keyword(s):  
New Zealand ◽  
Activation Parameters ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Response Team

Unplanned ICU Admission From Hospital Wards After Rapid Response Team Review in Australia and New Zealand

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Judit Orosz ◽  
Michael Bailey ◽  
Andrew Udy ◽  
David Pilcher ◽  
Rinaldo Bellomo ◽  
...  
Keyword(s):  
New Zealand ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Icu Admission ◽  
Response Team ◽  
Hospital Wards

scholarly journals A taxonomy of Australian and New Zealand paramedic clinical roles

2021 ◽  
Vol 18 ◽  
Author(s):  
Matt Wilkinson-Stokes
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Life Support ◽  
Advanced Life Support ◽  
Urban Search And Rescue ◽  
Special Operations ◽  
International Perspectives ◽  
Extended Care ◽  
Road Crash ◽  
Postgraduate Diploma

IntroductionThis article aims to summarise and categorise the current types of frontline paramedics in Australia and New Zealand, their relative scopes of practice, their qualifications and training, and the titles used in each jurisdictional ambulance service. Methods Each of the 10 jurisdictional ambulance services were contacted and their current clinical roles discussed with a manager or senior paramedic between June and October 2020. Information was summarised in tables and text.  ResultsMinimum qualifications for paramedics range from a diploma to an undergraduate degree, with graduate programs ranging from six to 18 months’ duration. Additional minimum qualifications for Extended Care Paramedics range from no minimum qualifications to a nursing degree. Additional minimum qualifications for Intensive Care Paramedics range from no minimum qualifications to a postgraduate diploma. Additional minimum qualifications for Retrievalists range from no minimum qualifications to a master degree. Helicopter emergency medical services (HEMS) teams range from primarily physician-led in four services to autonomous paramedics in five services. Armed offender paramedics exist in four services; urban search and rescue paramedics exist in five services; wilderness paramedics exist in five services; CBRNE paramedics exist in three services; mental health paramedics exist in three services. Special Operations variously refers to HEMS, USAR, CBRNE or armed offender. Critical Care variously refers to Intensive Care, HEMS in a physician-led team and autonomous HEMS. Advanced life support refers to paramedics and intensive care. Rescue Paramedic refers to road crash extrication or wilderness paramedics. Flight Paramedic refers to Paramedics or Intensive Care Paramedics, either HEMS or fixed wing. ConclusionThe jurisdictional ambulance services are heterogenous in the structure, qualifications, training and terminology for their frontline paramedic roles. Due to this lack of consistency, roles for paramedics in Australasia are currently largely incomparable between services, rendering shared titles inoperable from intranational and international perspectives.

Abstract 355: Using Low-Fidelity Simulation with Hospital Specific Equipment to Improve Front Line Nursing Staff Knowledge, Skill, and Confidence in a Code Blue

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Shauna R McCullough-Leewright
Keyword(s):  
Nursing Staff ◽  
Life Support ◽  
Advanced Life Support ◽  
Rapid Response Team ◽  
Front Line ◽  
Improve Performance ◽  
Document Code ◽  
Code Blue ◽  
Response Team ◽  
Facility Staff

Introduction: At this facility, staff response to unresponsive victims prior to arrival of Rapid Response Team is unreliable. The gaps in care reported by debrief forms include unable to find and use equipment on the crash cart, unable to appropriately document Code Blue in EHR, and not performing adequate CPR. Currently, the nursing staff is required to maintain Basic Life Support (BLS) and Advanced Life Support (ALS) (per their job description) via the Resuscitation Quality Improvement (RQI) program. RQI delivers quarterly training via computer scenarios and mannequin simulations. There is no consideration in RQI for hospital specific equipment or processes. The recommendation for improving staff response to code situations is to incorporate an annual Mock Code Event for all nursing staff to improve performance during code situations, in addition to RQI quarterly activities. Hypothesis: Participating in an instructor led Mock Code Event annually to review hospital specific equipment and processes, along with the quarterly RQI simulations, will improve staff response to code blue situations. Methods: The Mock Code Event included stations to review items in crash cart, use of defibrillator, documenting in EHR, and review of BLS. After completing the stations, the staff participated in a low-fidelity code blue simulation with a debrief. At end of activity, participants voluntarily completed a survey regarding Mock Code Event. Results: The participants scored 6 items on a Likert scale (from 1 disagree to 5 agree). 457 RNs and PCTs attended Mock Code Events in 2019. 189 completed survey after event. Conclusion: The survey findings demonstrate the Mock Code Event was an effective method to improve knowledge, skill, and confidence of front-line staff during Code Blue situations. The survey findings support that the educational techniques used were helpful and easy to understand.

scholarly journals The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa

2022 ◽  
Vol 27 ◽  
Author(s):  
Pradeep Ashokcoomar ◽  
Raisuyah Bhagwan
Keyword(s):  
South Africa ◽  
Critically Ill ◽  
Transfer Process ◽  
Life Support ◽  
Advanced Life Support ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Team Members ◽  
Healthcare Facilities ◽  
Tertiary Hospitals

Background: Neonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation).Aim: The aim of the study was to explore neonatologists’ views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers.Setting: The setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape.Method: A qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used.Results: The themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governanceConclusion: The study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates.Contribution: The findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.

Mise en place et organisation d’une équipe médicale mobile de réponse précoce aux urgences intra-hospitalières (Rapid Response Team)

2020 ◽  
Author(s):  
Boris Jung ◽  
Gerald Chanques ◽  
Samir Jaber ◽  
Kada Klouche
Keyword(s):  
Rapid Response Team ◽  
Rapid Response ◽  
Prise En Charge ◽  
Response Team

La mise en place d’une Rapid Response Team a pour objectif la mise en place d’une structure de réponse hospitalièrepour la prise en charge des urgences vitales et surtout une réponse précoce à la dégradation clinique des patientshospitalisés avant que l’urgence vitale ne survienne. Nous discutons dans ce manuscrit le rationnel et le niveau depreuve motivant la mise en place d’une Rapid Response Team ainsi que les freins qui doivent être surmontés pour lesuccès de cette mise en place.

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