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Journal Article > Study
Johnston M, Arora S, King D, Stroman L, Darzi A. Surgery. 2014;155:989-994.
This interview study examined escalation of care, the process by which a patient's deteriorating clinical status is recognized and acted upon, among surgical patients. Attending surgeons, trainees, intensivists, and rapid response team members believe that protocols for escalation of care lack clarity and that there is a dearth of supervision from senior clinicians. Similar to studies of handoffs, direct conversation—either in person or via mobile phone—was deemed preferable to hospital paging systems. Participants identified communication training, explicit and clear protocols, and increased supervision as key to improving the care of deteriorating surgical patients. Accompanying editorials highlight the importance of communication and the need for a safety culture that supports multidisciplinary teams.
Journal Article > Review
Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death of critically ill adult patients on general hospital wards.
McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Cochrane Database Syst Rev. 2007;(3):CD005529.
Medical emergency teams (also referred to as rapid response teams or critical care outreach teams) are being widely implemented in the US and worldwide. However, their effect on clinical outcomes remains controversial, as a prior commentary found no conclusive evidence of benefits. This systematic review found that most studies of medical emergency teams were of such poor methodologic quality that their results could not be generalized. Only two prospective controlled studies of outreach teams were identified, which demonstrated mixed results on patient outcomes.
Journal Article > Review
Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward.
Gao H, McDonnell A, Harrison DA, et al. Intensive Care Med. 2007;33:667-79.
Rapid response teams are being widely implemented in hospitals worldwide. These teams are summoned to evaluate patients who meet specific clinical "triggers" (e.g., abnormal vital signs). This systematic review evaluated the ability of such triggers to accurately identify inpatients whose clinical condition is deteriorating. The false-negative rate of commonly used triggers was relatively high, meaning that a significant proportion of acutely unstable patients would not be identified by such criteria. This problem was noted in a prior negative study of rapid response teams. The authors recommend further research to determine the combination of triggers that most accurately identifies clinical instability.