Factors associated with delayed activation of medical emergency team and excess mortality: An Utstein-style analysis

Tirkkonen, Joonas; Ylä-Mattila, Jari; Olkkola, Klaus T.; Huhtala, Heini; Tenhunen, Jyrki; Hoppu, Sanna

doi:10.1016/j.resuscitation.2012.09.021

Cited by 75 publications

(70 citation statements)

References 29 publications

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“…(27) Institutional culture, therefore, can adversely influence professionals towards not executing activations in the correct time and consequently causing delays and worse outcomes. (27) This finding was also observed in the study of Tirkkonen et al 2013, in which even with the identification …”

Section: Discussionsupporting

confidence: 76%

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Rapid response team: what factors interfere with its performance

et al. 2018

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Objective. Describe the knowledge in the literature related to factors that influence the performance of response teams. Methods. Integrative review of the literature of articles published in Portuguese, English or Spanish between 2006 and 2016. The descriptors hospital rapid response equipment, cardiac arrest and hospital mortality were used for the search in the PubMed/ Medline, Lilacs -Bireme and CINAHL bibliographic databases. Results. 19 studies were included for the analysis. The results were categorized in: sociocultural barriers and institutional policies, late activation of the rapid response team, composition and/or strengthening of the team's capacity, and use of facilitating tools. The sociocultural barriers found were: the presence of interprofessional hierarchies and beliefs, the limitations of institutional policies were related to the lack of training and human resources deficit. Late activations increased mortality, duration of hospitalization, and admission Descriptors: hospital rapid response team; heart arrest; hospital mortality; critical care.Equipo de respuesta rápida: ¿qué factores interfieren con su desempeño?Objetivo. Describir el conocimiento en la literatura relacionado con factores que influyen en el desempeño de equipos de respuesta. Métodos. Revisión integradora de la literatura de artículos publicados en portugués, inglés o español entre 2006 a 2016. Se emplearon los descriptores hospital equipo de respuesta rápida, paro cardíaco y mortalidad hospitalaria para la búsqueda en las bases bibliográficas PubMed/Medline, Lilacs -Bireme y CINAHL. Resultados. Se incluyeron para el análisis 19 estudios. Los resultados se categorizaron en: barreras socioculturales y políticas institucionales; activación tardía del equipo de respuesta rápida; composición y/o fortalecimiento de la capacidad del equipo; y uso de herramientas facilitadoras. Las barreras socioculturales encontradas fueron: presencia de creencias y jerarquías interprofesionales. Las limitaciones de las políticas institucionales se relacionaron con la falta de capacitación y déficit de recurso humano. Las activaciones tardías aumentaron la mortalidad, la duración de la hospitalización y el ingreso del paciente a la unidad de cuidados intensivos. Los equipos compuestos por profesionales de cuidados intensivos mostraron una reducción en la mortalidad y en la ocurrencia de paro cardíaco. El uso de nuevas herramientas no promovió cambios en la respuesta del equipo. Conclusión. Los factores encontrados en esta revisión influyen en el desempeño del equipo de

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Section: Discussionsupporting

confidence: 76%

“…(9) There was no reduction of delayed activation even with monitoring of patients. (12) The causes for delayed activation were described as the presence of unnecessary information reported during the activation, hesitant speeches, and difficulty in locating the emergency event. (8) …”

Section: Full Text N=26 Excluded N=7mentioning

confidence: 99%

Rapid response team: what factors interfere with its performance

et al. 2018

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“…However, refuting evidence suggests that nurses are not able to detect or interpret signals of impending danger (Despins 2009) and that incomplete or absent EWS physiological variables are a significant factor in the failure of the trigger arm to detect patient deterioration (MERIT et al 2005, Chen et al 2009, Oliver 2010, Tirkkonen et al 2013. It is suggested that the process fails as a result of inconsistency in recording observations, calculation errors and not communicating vital sign abnormalities (Ludikhuize et al 2011, Mackintosh et al 2012.…”

Section: Recording Practices (Mechanism)mentioning

confidence: 99%

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

McGaughey

O’Halloran

Porter

et al. 2017

Journal of Advanced Nursing

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“…Our findings of delayed or absent MET calls in over 50% are of concern, since studies showed an association between MET consult delays and SAEs [10,[14][15][16][17]25] . Regular monitoring of vital signs is the first and foremost step of the afferent procedure for detecting critically ill patients.…”

Section: Discussionmentioning

confidence: 58%

Effect of implementation of a rapid response system on protocol adherence in a surgical ward

Simmes

Schoonhoven²,

Mintjes

et al. 2013

JHA

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Objective: To describe the implementation of a rapid response system and adherence to its afferent limb in order to identify key elements for improvement. Implementation:We developed a multifaceted implementation strategy to introduce the Rapid Response System (RRS) on a 60-bed surgical ward of a university hospital. The strategy included the use of clear objectives, key leaders, an early warning score (EWS) observation protocol and a two-tiered medical emergency team (MET) warning protocol, a 1-day training program including a before-after knowledge test, mandatory for nurses and optional for ward physicians, reminders and feedback. Study design and methods:We retrospectively analyzed a sample of 10,653 patient days and 101 medical records of patients with a serious adverse event (SAE). Outcome measures were EWS recording rates, the nurse to ward physician and the ward physician to the MET calling rates following abnormal EWS recordings, and the indicators triggering these calls.Results: EWS recordings were present in 90% of the day shifts, 88% of the evening shifts and 80% of the night shifts. EWSs were recorded at least once in 92/101 medical records in the three days before an SAE; in 91/101 records EWSs were abnormal at least once. In case of an abnormal score, the nurse called the ward physician once or more in 87% (79/91). After being called by the nurse, the ward physician called the MET once or more in 75% (59/79). However, in 18% (15/79) there was a delay of one or two days before the ward physician/MET was called. Overall, medical emergency team calls were absent or delayed in over 50%. Conclusions:After RRS implementation, recording of the EWS was high. Adequate warning in case of abnormal scores was suboptimal in nurses as well as ward physicians. Future implementation strategies should therefore be aimed at the interdisciplinary team.

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Factors associated with delayed activation of medical emergency team and excess mortality: An Utstein-style analysis

Cited by 75 publications

References 29 publications

Rapid response team: what factors interfere with its performance

Rapid response team: what factors interfere with its performance

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

Effect of implementation of a rapid response system on protocol adherence in a surgical ward

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