A multi-dimensional program of practice change has been implemented in one setting and is providing a forum for discussion of practice-related issues and improvements. Adaptation of these strategies to multiple different health care settings is possible, with the potential for sustained practice change and improvement.

The 2-tier RRS was accessed by staff to assist with care of deteriorating patients in a large, tertiary hospital. High levels of satisfaction have been reported by clinical staff.

Purpose:The purpose of this study was to examine the current utilisation of altered rapid response call criteria (ARRCC) at a tertiary hospital. Methods :A retrospective review of all acute care admissions across 17 months was undertaken using the hospital administration system and electronic medical record to identify patients with ARRCC. In patients with altered criteria, the type of alteration, frequency of rapid response call, cardiac arrest, intensive care admission and death in hospital were identified.Comparisons were made using standard statistical methods.Results : Total hospital admissions numbered 45,912, with ARRCC used in 768 (1.7%) of these. Patients with an ARRCC during hospital admission were older (68.5 [55.5, 79.0] vs 59.0 [43.0, 72.0] years, p<0.001) and had a significantly longer length of hospital stay (6.9 [3.0,16.3] vs 2 [1,5] days, p<0.001).Compared with the total group of patient admissions, patients with ARRCC more frequently triggered a rapid response team (9.0% vs 14.2%, X 2 (1, n=46680) = 23.87, p<0.001), more frequently suffered a cardiac arrest (0.2 vs 0.9%, X 2 (1, n=46678) = 20.34, p<0.001), more frequently died in hospital (p<0.001), and less frequently were discharged home (X 2 (1, n=46680) = 43.91, p<0.001). Conclusion :Patients with an ARRCC stayed longer in hospital and were at increased risk of cardiac arrest and death during hospitalisation. Further exploration of the role of ARRCC in facilitating individualised care to meet the needs and treatment goals of each patient in the acute hospital setting is required.

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