Cohort study to test the predictability of the Melbourne criteria for activation of the medical emergency team

Edwards, Elizabeth Dawn; Mason, Brendan; Oliver, Alison; Powell, Colin

doi:10.1136/adc.2010.187617

Cited by 21 publications

(21 citation statements)

References 18 publications

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“…Our previous study found using a snap shot methodology that 42% of all potential RRS activations were in fact not made [10,11]. However, the importance of this is unclear, when the positive and negative predictive value of the various activation criteria, are so low [12][13][14][15]23]. However, from a more practical standpoint, our organisation was principally concerned with the missed/delayed RRS activation that was associated with patient harm to such a degree that either intensive care admission was required or, worse, that a cardiac arrest occurred.…”

Section: Study Limitationsmentioning

confidence: 98%

“…Attempts to validate such rules have demonstrated that, on the whole, the activation criteria have reasonable negative predictive value. However, the adherence to rules invariably has a poor positive predictive value generally due to low sensitivity of the criteria [12][13][14][15]. For the clinician faced with using the RRS this translates to a set of rules that mean the RRS must be called, but the net result of that is that there is minimal to no intervention and the patient does just fine sitting there in their ward bed [23].…”

Section: Study Significancementioning

confidence: 99%

“…On the one occasion that they erred there was significant cost to both the patient and the organization. In essence, both the sensitivity and specificity of commonly utilized RRS activation criteria are too low to significantly change ward staff beliefs about the RRS [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Getting more efficient Rapid Response System (RRS) utilization by the use of a general ward based deteriorating patient contract

et al. 2015

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Objective: To determine if a general ward-based plan to address the deteriorating patient could improve RRS utilization over and above a mandatory organizational policy and procedure. Design: A two stage methodology: First, engagement with ward providers and users of the RRS to generate ward-based interventions; Second, measurement of the incidence of missed/delayed RRS calls, RRS calls, cardiac arrests and unplanned intensive care unit admission both prior to the intervention and 12 months post implementation. Setting: Monash Health is a comprehensive healthcare network with 570 adult in-patient beds across four metropolitan teaching hospitals in the south-eastern sector of Melbourne. Results:The interventions selected for intervention were: (1) a ward based agreement on how to best locally optimize management of the deteriorating patient,(2) an improved communication protocol, and (3) a revision of the education program for staff. Post intervention the aggregate rate of missed/delayed RRS calls reduced across all wards (1.05 to 0.34 per 1000 bed days, p = 0.049). This occurred without a change in the rate of RRS activation (7.98 per 1000 bed days pre-intervention versus 7.85 bed days post-intervention). The incidence of cardiac arrests or unplanned interventions did not change post intervention. Conclusions: Engagement of the users of a system like the RRS activation protocol can improve compliance rates with protocols when the users have ownership of the process.

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Section: Study Limitationsmentioning

confidence: 98%

Section: Study Significancementioning

confidence: 99%

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Getting more efficient Rapid Response System (RRS) utilization by the use of a general ward based deteriorating patient contract

et al. 2015

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“…Most EWS use expert-derived normal ranges for age [9,40,41]. However, recent data suggests that normal distributions for heart and respiratory rate in well and sick hospitalized children are significantly different from published ranges [41, 42•].…”

Section: Normal Abnormal and Normally Abnormal Vital Signsmentioning

confidence: 99%

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

Levin

Brady

Duncan

et al. 2015

Curr Treat Options Peds

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Opinion statementRapid response systems (RRSs) aim to identify deteriorating hospitalized patients outside of the intensive care unit, respond quickly, and escalate to a higher level of care if needed. Despite a decade of evaluation, how to best design an RRS is still under study and debate. When considering your RRS, our recommendation is to start with the outcomes: what improvements in patient care are most needed in your environment? These may include reducing cardiac arrest or mortality, reducing critical deterioration, reducing length of stay in intensive care, or avoiding all preventable patient harm. Then, select a strategy for identification of at-risk patients, a response team structure that meets your institution's needs, and a quality improvement and governance structure to ensure you monitor process and outcome variables. The identification limb detects at-risk patients. For this, we recommend an aggregate pediatric early warning score (EWS), clear guidance regarding monitoring type and frequency, flagging of diagnostic risk factors, and a mandatory escalation system that uses the expertise of nurses, patients, and families and works around barriers to enhance response team activation. The structure and function of the response limb are also dependent upon the needs of the institution. We recommend a multidisciplinary team with the skills and resources to assess and manage emergencies. Proactive identification through a rover team or scheduled safety huddles may help with earlier identification of at risk patients. The quality improvement and governance structure should be designed around the desired outcomes. Regular monitoring and review of successes, near misses, and failures are vital for the system to improve outcomes.

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“…The Cardiff system has undergone a prospective evaluation and also applied the Australian MET system to its own unit 25 26. In both the Cardiff studies, the systems had reasonable sensitivities but at the cost of low specificity and positive predictive value, that is, few critical children were missed but a number of children activated unnecessarily.…”

Section: Development Of Children's Systemsmentioning

confidence: 99%

Republished: Paediatric early warning scores: Holy Grail and Achilles' heel

Roland

2013

Postgraduate Medical Journal

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Early Warning Scores (EWS) have become increasingly used by hospitals throughout the world to prevent unexpected admission to intensive care or even death in their inpatient population. It is well known that signs of deterioration are present well before collapse and by a combination of systems, EWS enable healthcare professionals to intervene at an appropriate time. A number of national bodies and regulators in the UK have required the use of Early Warning Scores in locations where children are inpatients. This article attempts to describe the background to their development, identify common problems and provide information for units interested in introducing an EWS into their department.

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Cohort study to test the predictability of the Melbourne criteria for activation of the medical emergency team

Cited by 21 publications

References 18 publications

Getting more efficient Rapid Response System (RRS) utilization by the use of a general ward based deteriorating patient contract

Getting more efficient Rapid Response System (RRS) utilization by the use of a general ward based deteriorating patient contract

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

Republished: Paediatric early warning scores: Holy Grail and Achilles' heel

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