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

Abstract

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.

Rapid response team: what factors interfere with its performance

“…(29) Regarding the professionals' lack of adherence to protocols, it was observed that better knowledge and familiarity with the instruments of criteria to evaluate the signs can increase adherence to activation of the teams, avoiding delays. (30) The team's composition may vary for each hospital, and most have a doctor leading the team. The need for the doctor in the RRT as a factor that can interfere with its efficiency is still controversial.…”

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

“…[10][11][12] Cognitive aids target all 3 key domains associated with the timely recognition and effective management of complications in the surgical population 13 : they improve communication, 14,15 teamwork and leadership, [15][16][17] and the surgical safety culture [17][18][19] and are therefore likely to be effective in decreasing failure to rescue. More specifically, they accelerate escalation of care 20 and optimize resuscitation by reducing the amount of omitted critical treatment steps. 21 To our knowledge, there are no cognitive aids for the management of deteriorating surgical patients.…”