The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
Thiele L, Flabouris A, Thompson C. PLoS ONE. 2022;17:e0269921.
Patient and family engagement is essential for safe healthcare. This single-site study found that while most clinicians perceived that patients and families are able to recognize clinical deterioration, clinicians expressed less favorable perceptions towards escalation processes when patients or families have concerns about clinical deterioration.
Hillman KM, Chen J, Jones D. Med J Aust. 2014;201:519-21.
Rapid response systems have been widely accepted as a method to improve outcomes of hospitalized patients demonstrating signs of rapid deterioration. This commentary provides an overview of rapid response systems, including factors that influence their effectiveness in enhancing safety, resources and educational programs required to support implementation, and associated improvements in mortality rates following deployment.
Chen J, Ou L, Hillman KM, et al. Med J Aust. 2014;201:167-70.
Although rapid response teams have been widely advocated, the evidence for their benefit remains mixed. This observational study sought to analyze the incidence of inpatient cardiopulmonary arrest and related mortality while rapid response teams were being implemented in Australia. Between 2002 and 2009, the mortality associated with inpatient cardiopulmonary arrests decreased over time. The authors found that most of the decline was due to decreased incidence of arrest, not increased survival following arrest. This finding suggests that rapid response did not play a significant role in reducing mortality from in-hospital arrest in this population, consistent with prior studies.
Hughes C, Pain C, Braithwaite J, et al. BMJ Qual Saf. 2014;23:714-7.
This commentary describes the design and implementation of a patient charting initiative based on principles from a surf lifesaving program in Australia. The intervention standardized documentation of patients' vital signs to create visual triggers for timely launch of a medical emergency team.
Jones D, Bagshaw SM, Barrett J, et al. Crit Care Med. 2012;40:98-103.
In this study, conducted at seven hospitals in three countries, nearly one-third of patients seen by a rapid response team ultimately had limitations placed on their care (such as do-not-resuscitate orders). This finding indicates a need for improved advanced care planning.
Jones D, DeVita MA, Bellomo R. N Engl J Med. 2011;365:139-46.
… The New England journal of medicine … N Engl J Med … Delays in clinical deterioration recognition and … as strategies to implement them successfully. An AHRQ WebM&M perspective discusses lessons from early experiences with …
Flabouris A, Chen J, Hillman K, et al. Resuscitation. 2010;81:25-30.
Nearly all of the calls to a rapid response team in this large Australian study required critical care interventions such as airway management or use of inotropic drugs. Calls were also significantly more common during morning hours.
Calzavacca P, Licari E, Tee A, et al. Resuscitation. 2010;81:31-5.
Rapid response systems (RRS), implemented to treat the clinically deteriorating patient, have now been well studied, including studies examining their impact on cardiac arrests, mortality, and even end-of-life care. This observational cohort study compared the use of and outcomes from medical emergency teams (MET) 5 years after their implementation to those found at the time of initiation. The study found fewer unplanned ICU admissions and MET activation delays in experienced systems, suggesting that RRS may need to mature before their full impact is felt. This finding adds to the ongoing debate about and tension regarding the impact of RRS. A past AHRQ WebM&M perspective discussed early lessons from rapid response team implementation.
Bagshaw SM, Mondor EE, Scouten C, et al. Am J Crit Care. 2010;19:74-83.
Nurses in this study valued medical emergency team (MET) systems, but they also pointed out barriers to activation, including fear of criticism and adherence to the more traditional model of contacting the responsible physician first. Fear of criticism was a finding not reported in a past study of nursing attitudes about MET systems.
Chen J, Bellomo R, Flabouris A, et al. Crit Care Med. 2009;37:148-53.
The largest study of rapid response systems to date, the MERIT trial was conducted in 23 Australian hospitals and did not demonstrate overall improvement in clinical outcomes. However, a limitation of this study was that the rapid response team was not actually called to evaluate the majority of patients who subsequently suffered a cardiac arrest. This retrospective analysis of data from the same study found evidence for a "dose-response" relationship between rapid response team use and clinical outcomes, in that early activation of the team was associated with a reduction in cardiac arrests.
Chen J, Flabouris A, Bellomo R, et al. Resuscitation. 2008;79:391-7.
Rapid response systems (RRS, sometimes also termed medical emergency teams) are designed to intervene promptly on inpatients whose clinical condition is acutely deteriorating. Early RRS studies also demonstrated an additional role: evaluating the goals of care and potentially instituting "do-not resuscitate" (DNR) orders when appropriate. This analysis of data from a previous randomized trial of RRS found that such teams did in fact result in a significant increase in DNR orders compared to hospitals without RRS, although the magnitude of this effect was small (approximately 4 additional DNR orders per 10,000 admissions). Though widely implemented, RSS remain controversial due to conflicting evidence regarding their effectiveness on clinical outcomes.