2007, Number 2
Next >>
Med Sur 2007; 14 (2)
Are there hospitals or patients sick? Rapid response team. First part
Carrillo ER, Carrillo CJR, Carrillo CLD
Language: Spanish
References: 30
Page: 47-55
PDF size: 103.19 Kb.
ABSTRACT
As health care professionals and institutions strive to improve patient safety, the treatment of deteriorating patients in noncritical care areas of hospitals has come under great scrutiny. As there is evidence that deteriorating patients receive delayed and substandard care, a number of initiatives have been proposed to improve both the detection and treatment of such patients. Hospitals should create systems to prevent patients from deteriorating and to identify and treat them if they do. Implementation of Rapid Response Teams (RRT) programs is one option, but introducing hospitalists or nurse practitioners or increasing nurse staffing may not only identify and treat deteriorating patients earlier but may also prevent such deteriorations to begin with. Rapid response team programs often provide a system for educating caregivers (nurse, physicians, respiratory therapists, and others) in the recognition of the signs and symptoms of physiological instability, developing “Alert Criteria”, and activating team of clinicians who come to the patient’s bedside for direct evaluation, treatment, and possibly triage to another setting such as the operating room or an intensive care unit. The hospitalwide operational and financial benefits of implementation of an RRT greatly outweigh the challenges of starting up an RRT. Benefits include improved safety of patients, shorter hospitals stays, fewer blue code, fewer transfers to the intensive care unit, increased awareness and identification of alert criteria, decreased mortality and morbidity, increased satisfaction between nurses, physicians, patients and family. Developing a structured RRT for patient’s safety empowers all staff to operate at a higher competence level.
REFERENCES
Rogers A, Wei-Ting Hwang S, Aiken L, Dinges DF. The working hours of hospital staff nurses and patient safety. Health Aff 2004; 23: 202-212.
Clarke S, Aiken L. Failure to Rescue. Am J Nurs 2003; 103: 42-47.
Aiken L, Clarke S, Sloane DM, Sochalski J, Silber JH. Hospital staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288: 1987-1993.
Golsfield A, Reinertsen J. The 100,000 lives campaign: crystallizing standards of care for Hospitals. Health Aff 2005; 24: 1560-1570.
Institute for Healthcare Improvement. www.ihi.org/ihi/programs/campaign
Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. Br Med J 2002; 324: 387-390.
DeVita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, Auerbach A. Findings of the First Consensus Conference on Medical Emergency Teams. Crit Care Med 2006; 34: 2463-2478.
MaGlynn EA, Asch SM, Adams J. The quality of health care delivery to adults in the United States. N Engl J Med 2003; 348: 2635-2645.
Franklin C, Matthew J. Developing strategies to prevent in hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before event. Crit Care Med 1994; 22: 244-247.
Bellomo R, Goldsmith D, Uchino S. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 2004; 32: 916-921.
Lee A, Bishop G, Hillman KM, Daffurn K. The medical emergency team. Anaesth Intensive Care 1995; 23: 183-186.
Edson BS, Williams MC. 100,000 lives campaign and the application to children. J Spec Pediatr Nurs 2006; 11: 138-142.
Simmonds T. Best practice protocols: implementing a rapid response system of care. Nurs Manage 2005; 36: 41-59.
Thomas K, Force VM, Rasmussen D, Dodd D. Rapid Response Team. Challenges, Solutions, Benefits. Crit Care Nurse 2007; 27: 20-27.
Hillman K, Chen J, Cretikos M, Bellomo B, Brown D, Doig G, Finfer S, Flabouris A, for the MERIT study investigators. Introduction of the medical emergency team (MET) system: a cluster randomized controlled trial. Lancet 2005; 365: 2091-2097.
Lecky F, Woodford M, Yates DW. Trends in Trauma Care in England and Wales 1989-97. Lancet 2000; 355: 1771-1775.
Nathes AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. The effect of organized systems of trauma care on motor vehicle crash mortality. J Am Med Assoc 2000; 283: 1990-1994.
Academic Rapid Response Team Collaborative. Association of American Medical Colleges, Institute for improving Clinical Care. http://www.aamc.org/patientcare/iicc/initiatives.htm
Joint Commission on Accreditation of Healthcare Organizations. The joint Commission announces the 2006 National Patient Safety Goals and requirements. Jt Comm Perspect 2005; 25: 1-10.
Auerbach AD, Wachter RM, Katz P. Implementation of a voluntary hospitalist service at a community teaching hospital: improved clinical efficiency and patient outcomes. Ann Intern Med 2002; 137: 859-865.
Buist M, Bellomo R. MET: the emergency medical team or the medical education team? Crit Care Resusc 2004; 6: 88-91.
Kenward G, Castle N, Hodgetts T, Shakin L. Evaluation of a medical emergency team one year after implementation. Resucitation 2004; 61: 257-263.
Bellomo R, Goldsmith D, Uchino S. A prospective before-and-after trial of a medical emergency team. Med J Aust 2003; 179: 283-287.
Bellomo R, Goldsmith D, Uchino S. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 2004; 32: 916-921.
Pittard AJ. Out of reach? Assesing the impact f introducing a critical care outcome service. Anesthesia 2003; 58: 882-885.
Buist M, Moore GE, Bernard SA. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrest: a preliminary study. BMJ 2002; 324: 387-390.
DeVita MA, Braithwaite RS, Mahidhara R. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care 2004; 13: 251-254.
Goldhill DR, Worthington L, Mulcany A, Tarling M, Summer A. The patient at-risk team: Identifying and managing seriously ill ward patients. Anaesthesia 1999; 54: 853-860.
Bristow PJ, Hillman KM, Chey T. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust 2000; 173: 236-240.
Priestley G, Watson W, Rashidian A. Introducing critical care out-reach: a ward randomized trial of phased introduction in a general hospital. Intensive Care Med 2004; 30: 1398-1404.