scholarly journals Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1194
Author(s):  
Reiko Okawa ◽  
Tomoe Yokono ◽  
Yu Koyama ◽  
Mieko Uchiyama ◽  
Naoko Oono
Keyword(s):  
Intensive Care ◽  
Care Management ◽  
Clinical Signs ◽  
Rapid Response Team ◽  
Curve Analysis ◽  
Rapid Response ◽  
Roc Curve Analysis ◽  
Intensive Care Management ◽  
Response Team ◽  
Vital Parameters

Background and Objectives: For effective function of the rapid response system (RRS), prompt identification of patients at a high risk of cardiac arrest and RRS activation without hesitation are important. This study aimed to identify clinical factors that increase the risk of intensive care unit (ICU) transfer and cardiac arrest to identify patients who are likely to develop serious conditions requiring ICU management and appropriate RRS activation in Japan. Materials and Methods: We performed a single-center, case control study among patients requiring a rapid response team (RRT) call from 2017 to 2020. We extracted the demographic data, vital parameters, blood oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) from the medical records at the time of RRT call. The patients were divided into two groups to identify clinical signs that correlated with the progression of clinical deterioration. Patient characteristics in the two groups were compared using statistical tests based on the distribution. Receiver operating characteristic (ROC) curve analysis was used to identify the appropriate cut-off values of vital parameters or FiO2 that showed a significant difference between-group. Multivariate logistic regression analysis was used to identify patient factors that were predictive of RRS necessity. Results: We analyzed the data of 65 patients who met our hospital’s RRT call criteria. Among the clinical signs in RRT call criteria, respiratory rate (RR) (p < 0.01) and the needed FiO2 were significantly increased (p < 0.01) in patients with severe disease course. ROC curve analysis revealed RR and needed FiO2 cut-off values of 25.5 breaths/min and 30%. The odds ratio for the progression of clinical deterioration was 40.5 times higher with the combination of RR ≥ 26 breaths/min and needed FiO2 ≥ 30%. Conclusions: The combined use of RR ≥ 26 breaths/min and needed FiO2 ≥ 30% might be valid for identifying patients requiring intensive care management.

A novel configuration of a traditional rapid response team decreases non-intensive care unit arrests and overall hospital mortality

2015 ◽  
Vol 10 (6) ◽  
pp. 352-357 ◽  
Author(s):  
Daniel P. Davis ◽  
Steve A. Aguilar ◽  
Patricia G. Graham ◽  
Brenna Lawrence ◽  
Rebecca E. Sell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Response Team

scholarly journals Implementation of a Formal Debriefing Program After Pediatric Rapid Response Team Activations

2018 ◽  
Vol 10 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Linda Aponte-Patel ◽  
Arash Salavitabar ◽  
Pamela Fazzio ◽  
Andrew S. Geneslaw ◽  
Pamela Good ◽  
...  
Keyword(s):  
Intensive Care ◽  
Real Time ◽  
Health Professionals ◽  
Tertiary Care ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Staff Attitudes ◽  
Learning Opportunity ◽  
Respiratory Therapists ◽  
Response Team

ABSTRACT Background  Debriefing after pediatric rapid response team activations (RRT-As) in a tertiary care children's hospital was identified to occur only sporadically. The lack of routine debriefing after RRT-As was identified as a missed learning opportunity. Objective  We implemented a formal debriefing program and assessed staff attitudes toward and experiences with debriefing after pediatric RRT-As. Methods  Real-time feedback for pediatrics residents captured clinical and debriefing data for each RRT-A from July 2014 to June 2016. The debriefing on physiology, team communication, and anticipation of clinical deterioration was introduced in July 2015. To assess debriefing perceptions, residents, intensive care fellows, nurses, and respiratory therapists participated in anonymous preintervention and postintervention surveys. We also developed a workshop to teach residents how to lead debriefing. Results  Debriefing after RRT-As increased from 26% preintervention to 46% postintervention (P &lt; .0001). A total of 43 of 76 pediatrics residents (57%) attended at least 1 of 4 debriefing workshops. Both preintervention and postintervention, more than 80% (70 of 78 preintervention and 54 of 65 postintervention) of health professionals surveyed strongly agreed or agreed that there was a benefit to debriefing after RRT-As. Postintervention, 65% (26 of 40) of respondents strongly agreed or agreed that debriefing improved their understanding of the RRT-A process. The rate of debriefing was sustained at 46% (6 months after the end of the study period). Conclusions  Debriefing frequency after pediatric RRT-As significantly increased with the introduction of a formal debriefing program. A majority of health professionals and trainees reported this practice was a valuable experience.

Early Warning Score Communication Bundle: A Pilot Study

2018 ◽  
Vol 27 (3) ◽  
pp. 238-242
Author(s):  
Cheryl Gagne ◽  
Susan Fetzer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Warning ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Early Warning Scores ◽  
Response Team ◽  
Intensive Care Unit Nurses ◽  
The Impact

Background Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. Objective To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer. Methods After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation. Results Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002). Conclusion Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.

scholarly journals Effect of a Rapid Response Team on Patient Outcomes in a Community-Based Teaching Hospital

2014 ◽  
Vol 6 (1) ◽  
pp. 61-64 ◽  
Author(s):  
Ankur Segon ◽  
Shahryar Ahmad ◽  
Yogita Segon ◽  
Vivek Kumar ◽  
Harvey Friedman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Inpatient Mortality ◽  
Rapid Response Teams ◽  
Community Based ◽  
Code Blue ◽  
Response Team

Abstract Background Rapid response teams have been adopted across hospitals to reduce the rate of inpatient cardiopulmonary arrest. Yet, data are not uniform on their effectiveness across university and community settings. Objective The objective of our study was to determine the impact of rapid response teams on patient outcomes in a community teaching hospital with 24/7 resident coverage. Methods Our retrospective chart review of preintervention-postintervention data included all patients admitted between January 2004 and April 2006. Rapid response teams were initiated in March 2005. The outcomes of interest were inpatient mortality, unexpected transfer to the intensive care unit, code blue (cardiac or pulmonary arrest) per 1000 discharges, and length of stay in the intensive care unit. Results Rapid response teams were activated 213 times during the intervention period. There was no statistically significant difference in inpatient mortality (3.13% preintervention versus 2.91% postintervention), code blue calls (3.09 versus 2.89 per 1000 discharges), or unexpected transfers of patients to the intensive care unit (15.8% versus 15.5%). Conclusions The implementation of a rapid response team did not appear to affect overall mortality and code blue calls in a community-based hospital with 24/7 resident coverage.

1202: INTENSIVE CARE UNTETHERED: EXPANDING CRITICAL CARE THROUGH A NOVEL RAPID RESPONSE TEAM

2018 ◽  
Vol 46 (1) ◽  
pp. 585-585
Author(s):  
Rohit Gupta ◽  
Michael Kitz ◽  
Jennifer Wang ◽  
Allison Glasser ◽  
Sarah Connolly ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Response Team

Abstract P867: Stroke Facilitators Provide Support to the Intensive Care Unit Nurse

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Robin Dambrosio ◽  
Elizabeth Avis
Keyword(s):  
Intensive Care ◽  
Small Group ◽  
Patient Outcomes ◽  
Care Coordination ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Critically Ill Patient ◽  
Icu Patients ◽  
Complex Needs ◽  
Response Team

Purpose: The Stroke Program manager (SPM) collaborated with the Rapid Response Team Nurses (RRTRN) to develop a facilitator process for patients in the intensive care units (ICU) presenting with stroke symptoms. The SPM developed a process to include activation of the Rapid Response Team (RRT) which included dedicated RRTRNs for all non-ICU stroke alerts (SA). This new SA improved care coordination, patient outcomes and improved the nurse work environment. The SPM identified the need for a similar SA process in the ICUs. Jointly, the SPM and RRTRNs developed a process to expand the RRTRN role to facilitate SAs in all ICUs. Methods: The SPM proposed involvement of the RRTRNs in the SA for ICU patients to the RRT Subcommittee with the support of nursing leadership. This new process would involve the RRTRN responding to all SA activations in the ICU. Care coordination shifted to a leadership couplet: the RRTRN and the ICURN. Implementation included specialized education orientation and scripted materials. The ICU RNs were educated on this unique process. This cutting edge process was incorporated into the RRT matrix to accommodate simultaneous RRT and SA alert activations. The RRTRNs provided efficient care coordination, dependable documentation, enhanced patient outcomes and support to the ICU RN. Evaluation: Utilizing RRTRNs as stroke facilitators bolstered the stroke alert process in the ICUS. When a patient exhibits sudden stroke like symptoms, the RRTRNs bring their expertise to the bedside, specifically by achieving the stroke metrics. ICU patients already have complex needs and the addition of a stroke complication is not a common occurrence. Creating this small group of “stroke experts” outside the ICU transferred easily into the ICU setting. Since its implementation, the facilitated 60 ICU SA focusing on the aspects of stroke care while the ICU nurse continues to maintain the critically ill patient. Implications for Practice: ICU are often very specialized in the care they deliver, but a stroke can traverse all of those specialties. Developing a small group of experts in stroke, provided consistency, support, and overall better care and outcomes for a patient when every moment counts. Utilizing the existing group of RRTRNs was fiscally sound as well as practical.

scholarly journals Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital

2016 ◽  
Vol 25 (1) ◽  
pp. e9-e13 ◽  
Author(s):  
Stacey Humphreys ◽  
Balagangadhar R. Totapally
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Pediatric Intensive Care ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Sex Risk ◽  
Rapid Responses ◽  
Response Team ◽  
Outcomes For Children

Background Variability in disposition of children according to the time of rapid response calls is unknown. Objective To evaluate times and disposition of rapid response alerts and outcomes for children transferred from acute care to intensive care. Methods Deidentified data on demographics, time and disposition of the child after activation of a rapid response, time of transfer to intensive care, and patient outcomes were reviewed retrospectively. Data for rapid-response patients on time of activation of the response and unplanned transfers to the intensive care unit were compared with data on other patients admitted to the unit. Results Of 542 rapid responses activated, 321 (59.2%) were called during the daytime. Out of all rapid response activations, 323 children (59.6%) were transferred to intensive care, 164 (30.3%) remained on the general unit, and 19 (3.5%) required resuscitation. More children were transferred to intensive care after rapid response alerts (P = .048) during the daytime (66%) than at night (59%). During the same period, 1313 patients were transferred to intensive care from acute care units. Age, sex, risk of mortality, length of stay, and mortality rate did not differ according to the time of transfer. Mortality among unplanned transfers (3.8%) was significantly higher (P &lt; .001) than among other intensive care patients (1.4%). Conclusion Only 25% of transfers from acute care units to the intensive care unit occurred after activation of a rapid response team. Most rapid responses were called during daytime hours. Mortality was significantly higher among unplanned transfers from acute care than among other intensive care admissions.

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