Impact of the Proactive Rounding Team on Rapid Response System During COVID-19 Pandemic: A Retrospective Study From an Italian Medical Center

Abstract

Objective: During the coronavirus disease 2019 (COVID-19) pandemic a proactive rounding (PR) team was introduced in our clinical practice in order to recognize the clinical deterioration of the patient as soon as possible. This study aimed to evaluate the impact of the PR team on the rapid response system (RRS) workload with particular regard to the activity carried out, the mode of intervention, and the outcome of patients. Methods: In this retrospective study, the first period before the activation of the PR team (March 1, 2019, to February 29, 2020) and the second period after its activation (March 1, 2020, to March 1, 2021) were compared. Results: A total of 406 inpatient RRS activations were collected. The medical emergency team (MET) dose was 13 and 12.2 activations/1000 admitted patients per year while the incidence of unexpected cardiac arrests was 3.8 and 2.6 events/1000 admitted patients per year (p=0.10). MET response time was longer in the second period (3.5±1.6 minutes vs 4.5±2.6 minutes p<0.01). We recorded more RRS activations for medical patients than surgical ones; MET was activated more frequently by physicians than nurses and for less severe criteria. Patients admitted to the intensive care unit had lower Simplified Acute Physiology Score II (SAPS II) scores. Conclusions: The PR team introduced during the COVID-19 pandemic did not increase the RRS workload. In addition, it allowed an earlier activation of the MET, especially by physicians.

The associations between rapid response systems and their components with patient outcomes: A scoping review

“…1 for additional details of the screening process. Most studies reviewed fit within two categories: they examined the effects of rapid response implementation on patient outcomes ( Roasio et al., 2022 ; Aitken et al., 2015 ; Al-Rajhi et al., 2016 ; Blotsky et al., 2016 ; Chen et al., 2015 ; Davis et al., 2015 ; Davis et al., 2015 ; Jung et al., 2016 ; Kawaguchi et al., 2015 ; Kim et al., 2017 ; Ludikhuize et al., 2015 ; Menon et al., 2018 ; Noyes et al., 2015 ; Pirret et al., 2015 ; Gong et al., 2020 ; Mankidy et al., 2020 ; Oh et al., 2018 ; Viana et al., 2021 ; Yang et al., 2020 ), or they described rapid response systems and their associations with patient characteristics and outcomes ( Jung et al., 2022 ; Winterbottom and Webre, 2021 ; Avis et al., 2016 ; Bunch et al., 2019 ; Chan et al., 2016 ; Churpek et al., 2017 ; Jones et al., 2017 ; Kollef et al., 2017 ; Le Guen et al., 2015 ; Psirides et al., 2016 ; Silva et al., 2016 ; Smith et al., 2015 ; Stelfox et al., 2015 ; Sulistio et al., 2015 ). Generally, rapid response system implementation studies included scenarios in which the system implemented was the first iteration of its kind ( Al-Rajhi et al., 2016 ; Blotsky et al., 2016 ), was replacing an existing system ( Aitken et al., 2015 ), or added another tier of clinical experience or surveillance to an existing system ( Davis et al., 2015 ; Kawaguchi et al., 2015 ; Pirret et al., 2015 ).…”

“…Broad patterns of what rapid response system components were reported on in included studies were also assessed. A majority of studies (27 of 34) identified what rapid response system triggers were used ( Roasio et al., 2022 ; Aitken et al., 2015 ; Al-Rajhi et al., 2016 ; Blotsky et al., 2016 ; Chen et al., 2015 ; Davis et al., 2015 ; Jung et al., 2016 ; Kawaguchi et al., 2015 ; Kim et al., 2017 ; Ludikhuize et al., 2015 ; Jung et al., 2022 ; Menon et al., 2018 ; Noyes et al., 2015 ; Pirret et al., 2015 ; Gong et al., 2020 ; Oh et al., 2018 ; Viana et al., 2021 ; Yang et al., 2020 ; Bunch et al., 2019 ; Churpek et al., 2017 ; Kollef et al., 2017 ; Le Guen et al., 2015 ; Psirides et al., 2016 ; Silva et al., 2016 ; Smith et al., 2015 ; Stelfox et al., 2015 ; Sulistio et al., 2015 ); additionally, a majority of studies (28 of 34) also included at least some details related to member composition of their medical emergency teams ( Roasio et al., 2022 ; Aitken et al., 2015 ; Al-Rajhi et al., 2016 ; Blotsky et al., 2016 ; Davis et al., 2015 ; Davis et al., 2015 ; Jung et al., 2016 ; Kawaguchi et al., 2015 ; Kim et al., 2017 ; Ludikhuize et al., 2015 ; Jung et al., 2022 ; Menon et al., 2018 ; Noyes et al., 2015 ; Pirret et al., 2015 ; Gong et al., 2020 ; Mankidy et al., 2020 ; Oh et al., 2018 ; Viana et al., 2021 ; Yang et al., 2020 ; Winterbottom and Webre, 2021 ; Avis et al., 2016 ; Bunch...…”

“…Of the 34 studies reviewed, 27 described criteria that comprised triggers used to activate medical emergency team events. Of these studies, 11 described institutional triggers with no further analyses ( Roasio et al., 2022 ; Davis et al., 2015 ; Kawaguchi et al., 2015 ; Ludikhuize et al., 2015 ; Jung et al., 2022 ; Noyes et al., 2015 ; Gong et al., 2020 ; Oh et al., 2018 ; Yang et al., 2020 ; Kollef et al., 2017 ; Sulistio et al., 2015 ), and 9 studies reported frequencies of triggers used to activate medical emergency teams with no further analyses ( Aitken et al., 2015 ; Al-Rajhi et al., 2016 ; Blotsky et al., 2016 ; Jung et al., 2016 ; Menon et al., 2018 ; Pirret et al., 2015 ; Psirides et al., 2016 ; Silva et al., 2016 ; Stelfox et al., 2015 ). We noted variability across studies in how triggers were described and reported.…”

“…Multiple studies also described the medical emergency team as having a responsibility to round proactively in noncritical care areas to help detect deteriorating patients ( Roasio et al., 2022 ; Davis et al., 2015 ; Davis et al., 2015 ; Yang et al., 2020 ; Avis et al., 2016 ). Four studies found rapid responses systems were associated with some significant decreases in-hospital cardiac arrests or hospital mortality ( Davis et al., 2015 ; Davis et al., 2015 ; Yang et al., 2020 ; Avis et al., 2016 ).…”

Implementation of a critical care outreach team in a children’s hospital

“… 2 , 3 Low implementation may be attributed to few descriptions of successful pediatric programs in the literature and limited evidence for its benefit. 14 , 20 , 21 , 22 In this study, we describe the core features of a successfully implemented critical care outreach team within a fully resourced RRS. Core features of our CCOT include dedicated personnel for managing critical illness outside of the ICU, close integration with existing RRS processes to identify at-risk children, and in-person rounds to foster collaboration between ward and ICU teams.…”