@article{3596,
  keywords = {Adverse events, epidemiology and detection, Chart review methodologies, Human error, Incident reporting, Medical emergency team},
  author = {Andre Carlos Kajdacsy-Balla Amaral and Andrew McDonald and Natalie G. Coburn and Wei Xiong and Kaveh G. Shojania and Robert A. Fowler and Martin Chapman and Neill K J Adhikari},
  title = {Expanding the scope of Critical Care Rapid Response Teams: a feasible approach to identify adverse events. A prospective observational cohort.},
  abstract = {<p><b>INTRODUCTION: </b>Adverse events (AEs) affect 3-12% of hospitalised patients. These are estimates from a labour-intensive chart review process,which is not feasible outside research. Clinical deterioration on the wards triggers a rapid response teams (RRTs) consult and can be used to identify an AE prospectively.</p><p><b>OBJECTIVES: </b>To demonstrate the feasibility of using RRT to detect AEs and compare this methodology to the rates reported using an electronic safety reporting system.</p><p><b>METHODS: </b>Prospective observational cohort of RRT consults. Three independent physicians reviewed all cases for the occurrence of an AE and its preventability. We summarise AEs as rates per 1000 patient-days, and compared the rates between RRT and the safety reporting system using a Poisson model.</p><p><b>RESULTS: </b>There were 8713 hospital admissions, with 531 RRT consults and 247 (2.8%) cases included. Forty-four (17.8%) and 35 cases (14.2%) were judged as AEs and preventable AEs, respectively. RRT identified 0.52 AE/1000 patient-days, compared with 0.21 AE/1000 patient-days detected through the electronic safety reporting system (rate ratio 2.4, 95% CI 1.4 to 4.2, p=0.0014). Patients in surgical wards had more AEs (0.83/1000 vs 0.36/1000, p<0.01) and preventable AEs (0.70 vs 0.21, p<0.01) than patients in medical wards. Agreement for AE (κ 0.46, 95% CI 0.39 to 0.53) and preventable AE (κ 0.47, 95% CI 0.40 to 0.53) was moderate among reviewers.</p><p><b>CONCLUSIONS: </b>Reviewing RRT consults identified a high proportion of AEs and preventable AEs. This methodology detected twice as many AEs as the hospital's safety reporting system. RRT clinicians provide a complementary and more sensitive mechanism than traditional safety reporting systems to identify possible AEs in hospitals.</p>},
  year = {2015},
  journal = {BMJ Qual Saf},
  volume = {24},
  pages = {764-8},
  month = {12/2015},
  issn = {2044-5423},
  doi = {10.1136/bmjqs-2014-003833},
  language = {eng},
}