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 Characteristics and Outcomes of Patients Activated by Rapid Response Team Who Transferred to the Intensive Care Unit

2021 ◽  
Author(s):  
Song-I Lee ◽  
Jeong suk Koh ◽  
Yoon-joo Kim ◽  
Da Hyun Kang ◽  
Jeong Eun Lee
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Medical Center ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
High Heart Rate ◽  
Factors Affecting ◽  
Response Team

Abstract Background:The utilization of a Rapid response team (RRT) has influenced patient’s clinical outcomes in the general ward. However, characteristics of RRT-screened patients admitted in the ward or transferred to the intensive care unit (ICU) is unknown. Therefore, this study aimed to evaluate these factors.Methods:We conducted a retrospective study using patient’s data in a tertiary medical center in Korea between January 2016 and December 2017. Results: Total 1,096 patients were included; 389 patients were transferred to the ICU, and 707 patients stayed in the ward. The ICU group was more likely to be admitted for medical reasons, hepatobiliary disease, and high heart rate. More interventions were performed, hospital stays were longer, and 28-day and in-hospital mortality were higher in the ICU group. Multivariate logistic regression analyses showed that the risk factors affecting ICU admission were Sequential Organ Failure Assessment (SOFA) score, and National Early Warning Score (NEWS), platelet and lactate level. Transfer to the ICU was not associated with in-hospital mortality.Conclusions: Among RRT-activated patients, those with higher SOFA, NEWS scores, and lactate levels were more likely to transfer to the ICU. Therefore, these patients should be closely monitored and considered for ICU transfer.

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 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.

scholarly journals National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Joonas Tirkkonen ◽  
Sari Karlsson ◽  
Markus B. Skrifvars
Keyword(s):  
Observational Study ◽  
Early Warning ◽  
Prospective Observational Study ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Hospital Death ◽  
Hospital Patient ◽  
Response Team ◽  
National Early Warning Score

Abstract Background The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. Methods We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. Results The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively. Conclusions We found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

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 < .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.

Rapid response team-triggered procalcitonin measurement predicts infectious intensive care unit transfers*

2012 ◽  
Vol 40 (7) ◽  
pp. 2090-2095 ◽  
Author(s):  
Richard G. Wunderink ◽  
Emily R. Diederich ◽  
Maria Paula Caramez ◽  
Helen K. Donnelly ◽  
Stephanie D. Norwood ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Response Team
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