Search results for "Hospitals"

Clinical staff often fail to call rapid response teams to evaluate deteriorating patients, even when objective criteria for calling the team are met. This qualitative study of physicians and nurses at an Australian hospital found that an impaired culture of safety can result in failure to use the rapid response team when appropriate and can also lead to using the team as a workaround to compensate for poor interdisciplinary communication.

According to this survey of nursing leaders, they perceived that rapid response teams improve patient outcomes and safety culture. Evaluations of rapid response were usually informal and often did not capture standardized data. The authors advocate for future research to examine what different types of hospitals perceive as valuable in rapid response teams.

This systematic review found that rapid response systems or teams are widely used, but comprehensive evaluation of these systems is lacking. The authors call for a sociotechnical evaluation of this complex intervention in order to truly characterize its impact on safety.

This systematic review examined whether patient and family member activation of rapid response teams improved recognition of clinical deterioration. Studies demonstrated that patients and family members did not overwhelm rapid response capacity with frequent activations, but they did activate rapid response to convey concerns beyond clinical deterioration. The authors suggest further study is needed to determine how to best engage patients and families to detect clinical deterioration early.

Rapid response teams (RRTs) are a widely implemented safety intervention with a growing body of literature supporting their effectiveness. At some hospitals, families can activate the RRT if they are concerned. This systematic review identified successful implementation strategies for family-activated RRTs, but researchers found no clear evidence that this approach improves patient outcomes.

Hospitals require robust escalation of care processes to ensure that worsening conditions in critical patients are recognized and treated. This review discusses several strategies including rapid response teams and early warning systems to help prevent these situations from resulting in failure to rescue and preventable patient harm.

This three-part commentary presents differing views on whether rapid response teams (RRTs) improve patient outcomes and recommends that further research is required to determine ideal RRT staffing, factors that contribute to the need for an RRT, and how rapid response affects the safety of hospitalized patients.

Early recognition of sepsis is a patient safety issue, due to the time-sensitive nature of delivering evidence-based treatments. This article describes a Centers for Medicare and Medicaid Services–funded initiative to improve sepsis management in 15 facilities in Texas. Components included convening a leadership committee for performance improvement, educating bedside nurses and other staff, developing a screening tool in the electronic health record (EHR), standardizing a second responder protocol (like a rapid response team) for possible sepsis, and conducting audit and feedback for participating institutions. The authors noted challenges given that participating institutions used different EHRs, but they were able to implement EHR-based screening across all systems. Positive screens were evaluated by a second responder, but it is difficult to estimate the amount of second responder time needed for this intervention. Planned outcome measures, which are not yet available, include mortality, length of stay, and costs. A recent WebM&M commentary describes common errors in the early management of sepsis.

This study describes the introduction of a rapid response system (RRS) on a high-risk obstetric unit at a large academic medical center. The number of RRS activations over the first 3 years has steadily increased, which the researchers consider a marker of successful RRS integration.

Despite widespread implementation of rapid response systems, they remain controversial. This study showed that delayed activation of rapid response was associated with worse morbidity and higher mortality compared to timely rapid response implementation. This work adds to recent data suggesting that rapid response improves patient safety.

Engaging patients and their families to call rapid response teams (RRTs) has been promoted as a patient safety strategy. This literature review found that consumer education programs for RRT activation led to more RRT calls by both consumers and clinicians and decreased rates of patient mortality.

Rapid response teams have been championed as a strategy to improve hospital outcomes. However, evidence regarding their effectiveness is mixed, and rapid response teams remain controversial. In this pre-post study across multiple hospitals, the combined incidence of in-hospital death, cardiopulmonary arrest, and unplanned intensive care unit admission decreased following the introduction of rapid response teams compared to the pre-implementation time period. Although this study design does not offer definitive evidence that rapid response was the cause of the declining event rate, it does add support for the call in the National Patient Safety Goal to implement rapid response more widely. Barriers to rapid response team implementation include personnel costs as well as existing culture which may lead to reluctance to activate a rapid response.

This report of a quality improvement project to increase use of the rapid response team resulted in more frequent rapid response activation and a nonsignificant decrease in the number of code blue events occurring outside the intensive care unit. This intervention demonstrated staff behavior change, but its effect on patient outcomes remains unclear, adding to the mixed evidence about rapid response systems.

Rapid response systems, though controversial, have been widely implemented in acute care settings, but not emergency departments. In this pre-post study, rapid response implementation in an emergency department was associated with improved recognition of clinical deterioration, but investigators were not able to detect changes in patient outcomes. With these results, the data on rapid response systems remains inconclusive and suggests the need for more robust post-implementation data on effectiveness and costs.

Although rapid response programs have been advocated as promising patient safety strategies, the evidence regarding their benefits is mixed. This review provides an overview of rapid response systems, including key components and goals of the intervention. Further research is needed to provide justification on their use for adult patients.

This meta-analysis of rapid response systems concludes that despite the heterogeneity of included populations and varying study designs, rapid response teams do improve in-hospital mortality for pediatric and adult populations. This analysis supports the current widespread implementation of rapid response.

There is a consensus in the safety field that organizations must use multiple methods of detecting errors and adverse events, as individual approaches vary in their ability to identify different types of safety issues. Rapid response systems (RRSs) have been widely deployed to detect and stabilize deteriorating hospitalized patients, and this study investigated whether analysis of RRS activations could be used to identify preventable hazards. Systematic review of patients seen by the RRS revealed that almost 20% had experienced an adverse event, 80% of these were preventable, and most were not reported to the institution's incident reporting system. Hospitals should consider formal review of RRS activation as a trigger for identifying adverse events.

The introduction of a modified early warning system at a community academic medical center was associated with more rapid response team activations (from 0.24 to 0.48 per 100 patient-days), but fewer code blues and a decline in overall inpatient mortality (from 2.3% in 2011 to 1.5% in 2013).

Rapid response teams (RRTs) have been strongly endorsed by organizations including the Institute for Healthcare Improvement, largely based on early results that showed impressive benefits (although later studies were less positive). This study describes RRT programs in hospitals participating in a statewide collaborative that was established to help implement, evaluate, and sustain RRTs at acute care hospitals. Of the 56 hospitals in the collaborative, 31 hospitals responded to the survey, yielding a response rate of 55%. The authors describe the different organizational characteristics and RRT structures at these hospitals. Most of the teams included a critical care nurse and respiratory therapist. About 30% had a hospitalist and 23% reported the presence of a dedicated RRT nurse. Some best practices for safety, process improvement, and oversight were lacking in many of the programs. A prior AHRQ WebM&M perspective explored early lessons from RRTs.

This study of an after-hours rapid response team found that the team was not always activated as intended. More unplanned admissions to intensive care were identified following rapid response implementation, possibly due to enhanced surveillance for clinical deterioration. Under-utilization of rapid response may account for mixed results in improving patient safety.