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.
Sprogis SK, Street M, Currey J, et al. Aust Crit Care. 2021;34:580-586.
Medical emergency teams (MET), also known as rapid response teams, are used to improve the identification and management of patients demonstrating signs of rapid deterioration. This study found that modifying activation criteria to trigger METs at more extreme levels of clinical deterioration were not associated with negative patient safety outcomes.
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.
Mardegan K, Heland M, Whitelock T, et al. Jt Comm J Qual Patient Saf. 2013;39:570-575.
This study group created a standardized running sheet for documenting medical emergency team (MET) events at their medical center. About half of ward nurses felt that this tool improved patient handoffs to the arriving METs.
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.
Delays in clinical deterioration recognition and failures to rescue lead to serious adverse events. Rapid response systems (RRS) have been implemented with the aim of improving the identification and management of clinically worsening hospital ward patients. Although early studies reviewing RRS showed improvements in clinical outcomes, subsequent results have not shown consistent benefit. This review describes RRS, including controversies surrounding them, potential benefits and limitations, as well as strategies to implement them successfully. An AHRQ WebM&M perspective discusses lessons from early experiences with RRS.
The most common reason for rapid response system activation was concern on the part of a staff member (usually the bedside nurse). Objective criteria, such as vital sign abnormalities, were not used as frequently.
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.
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.
McGain F, Cretikos MA, Jones D, et al. Med J Aust. 2008;189:380-3.
This study discovered that incomplete nursing documentation postoperatively was associated with night shifts and patients not receiving epidural or patient-controlled analgesia. Incomplete medical documentation was noted more commonly on the weekends.
Quach J, Downey A, Haase M, et al. J Crit Care. 2008;23:325-31.
This study discovered that patients receiving a medical emergency team (MET) assessment tended to be elderly and had a mortality rate exceeding 35%, with the highest rates in those where the MET response was delayed.
Rowin EJ, Lucier D, Pauker SG, et al. Jt Comm J Qual Patient Saf. 2008;34:537-545.
Hospital incident reporting systems are ubiquitous but limited, as their voluntary nature results in many events going unreported. Prior research has documented that physicians, in particular, do not file incident reports. This evaluation of more than 260,000 incident reports from a broad cross-section of hospitals examined links between the severity of the incident and who reported the incident. Physicians reported only 1.1% of all events, similar to a prior study using the same incident reporting system, but physicians did tend to report incidents that caused more harm to patients. A successful intervention to improve physician incident reporting was described in a prior study.
Jones D, George C, Hart GK, et al. Crit Care. 2008;12:R46.
Medical emergency teams (METs) are a widely implemented safety intervention, but controversy remains regarding their effectiveness. This study took place in Australia and New Zealand, where a prior randomized trial found no overall effect of METs on clinical outcomes. While most hospitals have implemented an MET, death rates from cardiac arrest appeared to decrease over the study period at all hospitals, regardless of whether an MET was in place. Despite the equivocal results of larger studies, implementation and development of METs will likely continue due to the improvement in clinical outcomes found in single-center studies and the positive opinion of nurses regarding the teams.