Medical Rapid Response in Psychiatry: Reasons for Activation and Immediate Outcome

Abstract

Rapid response teams are used to improve the recognition of acute deteriorations in medical and surgical settings. They are activated by abnormal physiological parameters, symptoms or clinical concern, and are believed to decrease hospital mortality rates. We evaluated the reasons for activation and the outcome of rapid response interventions in a 222-bed psychiatric hospital in New York City using data obtained at the time of all activations from January through November, 2012. The primary outcome was the admission rate to a medical or surgical unit for each of the main reasons for activation. The 169 activations were initiated by nursing staff (78.7 %) and psychiatrists (13 %) for acute changes in condition (64.5 %), abnormal physiological parameters (27.2 %) and non-specified concern (8.3 %). The most common reasons for activation were chest pain (14.2 %), fluctuating level of consciousness (9.5 %), hypertension (9.5 %), syncope or fall (8.9 %), hypotension (8.3 %), dyspnea (7.7 %) and seizures (5.9 %). The rapid response team transferred 127 (75.2 %) patients to the Emergency Department and 46 (27.2 %) were admitted to a medical or surgical unit. The admission rates were statistically similar for acute changes in condition, abnormal physiological parameters, and clinicians' concern. In conclusion, a majority of rapid response activations in a self-standing psychiatric hospital were initiated by nursing staff for changes in condition, rather than for policy-specified abnormal physiological parameters. The findings suggest that a rapid response system may empower psychiatric nurses to use their clinical skills to identify patients requiring urgent transfer to a general hospital.

Effectiveness and experiences of mental health nurses in cases of medical emergency and severe physiological deterioration: A systematic review

“…We retained the study since a considerable proportion of the 280 'frontline' staff involved would be mental health nurses. Manu et al (2015) examined Rapid Response Team calls made over a 10-month period in a US psychiatric hospital and reported the proportion made by various disciplinary groups including nurses.…”

“…The most frequently used outcomes measure was the Physical Health Attitudes Scale for Mental Health Nurses (Robson & Haddad, 2012) Robson et al, 2013;Haddad et al, 2016;Ganiah et al, 2017;Bressington et al, 2018; the remaining seven involved purpose-designed interview or focus group schedules in qualitative studies (Shanley, 2012;Herisko et al, 2013), while the remaining studies used purpose-designed quantitative questionnaires Tenkanen et al, 2011;Flood et al, 2014;Herisko et al, 2015;Manu et al, 2015;Gebreegziabher et al, 2017). Physical Health Attitudes Scale for Mental Health…”

“…Uncertainty and apprehension often due to poor knowledge and lack of awareness can contribute to a 'blinkered' approach to physiological deterioration in mental health and can further contribute to what is often referred to as diagnositic overshadowing; where "physical and/or behavioural symptoms are inappropriately accredited to mental illness" (Geiss et al, 2018: p.327). Further the review also highlighted that factors such as the availability of rapid response teams seemed to have a positive effect in empowering mental health nurses with the autonomy to independently 'make the call' to escalate a situation if concerned; potentially heightening clinical judgement skills and perhaps should be used more widely in mental health practice (Manu et al, 2015).…”

“…There was agreement from most participants with statements suggesting that physical healthcare for psychiatric patients is complex (M[SD]=76.3[13.8]). Finally,Manu et al (2015) reported that the majority of 169 Rapid Response Team activations were made by staff nurses (72.8%). The authors concluded that the introduction of a empowered nurses to refer when the more traditional practice was for the patient's psychiatrist to call a medical consultant.…”

Evaluation of an immersive simulation programme for mental health clinicians to address aggression, violence, and clinical deterioration

“…The acute deterioration of patients with mental health conditions can manifest physiologically, cognitively or psychologically, often requiring emergency intervention (Manu et al . 2015; Porter et al . 2018).…”