Developing a Medical Emergency Team Running Sheet to Improve Clinical Handoff and Documentation

The type of medical review before an adverse event influences patient outcome. Delays in the up-transfer of patients requiring intensive care are associated with higher mortality rates. Timely detection and response to a deteriorating patient constitute an important function of the rapid response system (RRS). The activation of the RRS for at-risk patients constitutes the system’s afferent limb. Afferent limb failure (ALF), an important performance measure of rapid response systems, constitutes a failure to activate a rapid response team (RRT) despite criteria for calling an RRT.There are diurnal variations in hospital staffing levels, the performance of rapid response systems and patient outcomes. Fewer ward-based nursing staff at night may contribute to ALF. The diurnal variability in RRS activity is greater in unmonitored units than it is in monitored units for events that should result in a call for an RRT. RRT events include a significant abnormality in either the pulse rate, blood pressure, conscious state or respiratory rate. There is also diurnal variation in RRT summoning rates, with most activations occurring during the day. The reasons for this variation are mostly speculative, but the failure of the afferent limb of RRT activation, particularly at night, may be a factor.The term “circadian variation/rhythm” applies to physiological variations over a 24-h cycle. In contrast, diurnal variation applies more accurately to extrinsic systems. Circadian rhythm has been demonstrated in a multitude of bodily functions and disease states.For example, there is an association between disrupted circadian rhythms and abnormal vital parameters such as anomalous blood pressure, irregular pulse rate, aberrant endothelial function, myocardial infarction, stroke, sleep-disordered breathing and its long-term consequences of hypertension, heart failure and cognitive impairment. Therefore, diurnal variation in patient outcomes may be extrinsic, and more easily modifiable, or related to the circadian variation inherent in human physiology. Importantly, diurnal variations in the implementation and performance of the RRS, as gauged by ALF, the RRT response to clinical deterioration and any variations in quality and quantity of patient monitoring have not been fully explored across a diverse group of hospitals.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-016-0136-5) contains supplementary material, which is available to authorized users.

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“…The RRT subsequently does a handover to the home team [ 67 ]. Overnight, the RRT operates [ 68 ] like a “hospitalist” service.…”

Section: Diurnal Variation In Responding To Clinical Deteriorationmentioning

confidence: 99%

Diurnal variation in the performance of rapid response systems: the role of critical care services—a review article

2016

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“…Interestingly, in Phase 1, RRT users were overwhelmingly in favour of a (re-designed) structured hand-off process [3]. While users apparently support the concept of a formalised transfer of clinical responsibility [19], some aspects of the process implemented in this study did not appear to meet the needs of Phase 2 respondents. It seems likely that modification of a communication procedure may not, alone, be sufficient and that wider organisational cultural change is needed [25].…”

Section: Structured Hand-offmentioning

confidence: 67%

“…Insufficient financial and human resources were available at the investigating hospital to deliver an NTS training program for RRS staff. Therefore, a multifaceted re-design of the existing mature RRS was undertaken instead, incorporating themes from the TeamSTEPPS® program and previously reported RRS improvement initiatives, to promote use of NTS without the need for training [14,17,19,20].…”

Section: The Rrs Re-designmentioning

confidence: 99%

“…Successful completion of the RRT call requires that this transfer of care is not only acknowledged by those on both sides of the member-user interface but is also appropriate. Most importantly, this needs careful consideration regarding whether the patient's ongoing management needs can be safely and effectively delivered by that ward team [19,20].…”

Section: Team Role Badgesmentioning

confidence: 99%

“…Given these constraints, an alternative approach is to incorporate design elements into the RRS that would promote effective communication and cooperation within the RRS without the need for dedicated training [7,12,13]. Previous studies with similar objectives have reported modification of individual aspects of the RRS, albeit without detailed investigation of their effects on system performance [6,[14][15][16][17][18][19]. Therefore, the present study was conducted to describe and assess a multifaceted re-design of an RRS which aimed to improve the quality of RRT member-member and member-user communication and cooperation.…”

Section: Introductionmentioning

confidence: 99%

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Re-designing a rapid response system: effect on staff experiences and perceptions of rapid response team calls

Chalwin¹,

Giles²,

Salter³

et al. 2020

BMC Health Serv Res

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Background: Rapid Response Team (RRT) calls are clinical crises. Clinical and time pressures can hinder effective liaison between staff who call the RRT ('users') and those responding as part of the RRT ('members'). Non-technical skills (NTS) training has been shown to improve communication and cooperation but requires time and financial resources that may not be available in acute care hospitals. Rapid Response System (RRS) redesign , aiming to promote use of NTS, may provide an alternative approach to improving interactions within RRTs and between members and users. Methods: Redesign of an existing mature RRS was undertaken in a tertiary, metropolitan hospital incorporating the addition of: 1) regular RRT meetings 2) RRT role badges and 3) a structured member-to-user patient care responsibility "hand-off" process. To compare experiences and perceptions of calls, users and members were surveyed pre and post redesign. Results: Post redesign there were improvements in members' understanding of RRT roles (P = 0.03) and responsibilities (P < 0.01), and recollection of introducing themselves to users (P = 0.02). For users, after the redesign, there were improvements in identification of the RRT leader (P < 0.01), and in the development of clinical plans for patients remaining on the ward at the end of an RRT call (P < 0.01). However, post-redesign , fewer users agreed that the structured hand-off was useful or that they should be involved in the process. Both members and users reported fewer experiences of conflict at RRT calls post-redesign (both P < 0.01). Conclusion: The RRS redesign yielded improvements in interactions between members in RRTs and between RRT members and users. However, some unintended consequences arose, particularly around user satisfaction with the structured hand-off. These findings suggest that refinement and improvement of the RRS is possible, but should be an ongoing iterative effort, ideally supported by staff training. Trial registration: NCT01551160. Registered: 12th March 2012.

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Governance of the Rapid Response System

Heland

Jones

2017

Textbook of Rapid Response Systems

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Developing a Medical Emergency Team Running Sheet to Improve Clinical Handoff and Documentation

Cited by 8 publications

References 13 publications

Diurnal variation in the performance of rapid response systems: the role of critical care services—a review article

Diurnal variation in the performance of rapid response systems: the role of critical care services—a review article

Re-designing a rapid response system: effect on staff experiences and perceptions of rapid response team calls

Governance of the Rapid Response System

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