Rapid Response Team

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Rinaldo Bellomo - One of the best experts on this subject based on the ideXlab platform.

  • Rapid Response Team review of hemodynamically unstable ward patients the accuracy of cardiac index assessment
    Journal of Critical Care, 2019
    Co-Authors: Christopher T Eyeington, Glenn M Eastwood, Patryck Lloyddonald, Matthew J Chan, Helen Young, Leah Peck, Daryl A Jones, Rinaldo Bellomo
    Abstract:

    Abstract Purpose Intensive care doctors commonly attend Rapid Response Team (RRT) reviews of hospital-ward patients with hemodynamic instability and estimate the patient’s likely cardiac index (CI). We aimed to non-invasively measure the CI of such patients and assess the level of agreement between such measurements and clinically estimated CI categories (low Materials and methods A prospective, observational study of non-invasive measurement and clinical estimation of CI categories in 50 adult hospital-ward patients who activated the RRT for ‘hemodynamic instability’ (tachycardia > 100BPM or hypotension Results The CI was measured in 47/50(94%) patients and the mean CI was 3.5(95% CI 3.2-3.7) L/min/m2. Overall, 30(64%) patients had a high CI, 13(28%) and 4(9%) had a normal and a low CI, respectively. The level of agreement between measured and clinically estimated CI categories was low(19.2%). Sensitivity and positive predictive values of clinical estimation were low(0% and 3.3% for high CI, and 0% and 50% for low CI, respectively). Conclusions Non-invasive CI measurement was possible in almost all hospital-ward patients triggering RRT review for hemodynamic instability. In such patients, the CI was high, and intensive care clinicians were unable to identify a low or a high CI state.

  • laboratory alerts to guide early intensive care Team review in surgical patients a feasibility safety and efficacy pilot randomized controlled trial
    Resuscitation, 2018
    Co-Authors: Rinaldo Bellomo, Matthew J Chan, Christopher Guy, Helena Proimos, Federica Franceschi, Marco Crisman, Aniket Nadkarni, Paolo Ancona
    Abstract:

    Abstract Aim Common blood tests can help identify patients at risk of death, unplanned intensive care unit (ICU) admission, or Rapid Response Team (RRT) call. We aimed to test whether early ICU-Team review triggered by such laboratory tests (lab alert) is feasible, safe, and can alter physiological variables, clinical management, and clinical outcomes. Methods In prospective pilot randomized controlled trial in surgical wards of a tertiary hospital, we studied patients admitted for >24 h. We applied a previously validated risk assessment tool to each set of common laboratory tests to identify patients at risk and generate a “lab-alert”. We randomly allocated such lab-alert patients to receive early ICU-Team review (intervention) or usual care (control). Results We studied 205 patients (males 54.1%; average age 79 years; 103 randomized to intervention and 102 to usual care). Intervention patients were more likely to trigger RRT activation during their first lab-alert (10.7 vs. 2.0%; P  Conclusion Among surgical patients, lab alerts identify patients with a high mortality. Lab alert-triggered interventions are associated with more first alert-associated RRT activations; more changes in resuscitation status toward a more conservative approach; fewer subsequent alert-associated RRT activations; fewer subsequent alerts, and decreased allied health interventions (ANZCTRN12615000146594).

  • epidemiology of early Rapid Response Team activation after emergency department admission
    Australasian Emergency Nursing Journal, 2016
    Co-Authors: Juan Carlos Mora, Julie Considine, Daryl A Jones, Antoine G Schneider, Raymond J Robbins, Michael Bailey, Bronwyn Bebee, Yufeng Frank Hsiao, Rinaldo Bellomo
    Abstract:

    Summary Background Rapid Response Team (RRT) calls can often occur within 24h of hospital admission to a general ward. We seek to determine whether it is possible to identify these patients before there is a significant clinical deterioration. Methods Retrospective case–controlled study comparing patient characteristics, vital signs, and hospital outcomes in patients triggering RRT activation within 24h of ED admission (cases) with matched ED admissions not receiving a RRT call (controls). Results Over 12 months, there were 154 early RRT calls. Compared with controls, cases had a higher heart rate (HR) at triage (92 vs. 84beats/min; p =0.008); after 3h in the ED (91 vs. 80beats/min; p =0.0007); and at ED discharge (91 vs. 81beats/min; p =0.0005). Respiratory rate (RR) was also higher at triage (21.2 vs. 19.2breaths/min; p =0.001). On multiple variable analysis, RR at triage and HR before ward transfer predicted early RRT activation: OR 1.07 [95% CI 1.02–1.12] for each 1breath/min increase in RR; and 1.02 [95% CI 1.002–1.030] for each beat/minute increase in HR, respectively. Study patients required transfer to the intensive care in approximately 20% of cases and also had a greater mortality: (21% vs. 6%; OR 4.65 [95% CI 1.86–11.65]; p =0.0003) compared with controls. Conclusions Patients that trigger RRT calls within 24h of admission have a fourfold increase in risk of in-hospital mortality. Such patients may be identified by greater tachycardia and tachypnoea in the ED.

  • clinical review the role of the intensivist and the Rapid Response Team in nosocomial end of life care
    Critical Care, 2013
    Co-Authors: Andrew Hilton, Rinaldo Bellomo, Daryl A Jones
    Abstract:

    In-hospital end-of-life care outside the ICU is a new and increasing aspect of practice for intensive care physicians in countries where Rapid Response Teams have been introduced. As more of these patients die from withdrawal or withholding of artificial life support, determining whether a patient is dying or not has become as important to intensivists as the management of organ support therapy itself. Intensivists have now moved to making such decisions in hospital wards outside the boundaries of their usual closely monitored environment. This strategic change may cause concern to some intensivists; however, as custodians of the highest technology area in the hospital, intensivists are by necessity involved in such processes. Now, more than ever before, intensive care clinicians must consider the usefulness of key concepts surrounding nosocomial death and dying and the importance and value of making a formal diagnosis of dying in the wards. In this article, we assess the conceptual background, reference points, challenges and implications of these emerging aspects of intensive care medicine.

  • findings of the first consensus conference on medical emergency Teams
    Critical Care Medicine, 2006
    Co-Authors: Michael A Devita, Rinaldo Bellomo, Ken Hillman, John A Kellum, Armando J Rotondi, Daniel Teres, Andrew D Auerbach, Wenjon Chen, Kathy Duncan, Gary Kenward
    Abstract:

    BACKGROUND: Studies have established that physiologic instability and services mismatching precede adverse events in hospitalized patients. In Response to these considerations, the concept of a Rapid Response System (RRS) has emerged. The responding Team is commonly known as a medical emergency Team (MET), Rapid Response Team (RRT), or critical care outreach (CCO). Studies show that an RRS may improve outcome, but questions remain regarding the benefit, design elements, and advisability of implementing a MET system. METHODS: In June 2005 an International Conference on Medical Emergency Teams (ICMET) included experts in patient safety, hospital medicine, critical care medicine, and METs. Seven of 25 had no experience with an RRS, and the remainder had experience with one of the three major forms of RRS. After preconference telephone and e-mail conversations by the panelists in which questions to be discussed were characterized, literature reviewed, and preliminary answers created, the panelists convened for 2 days to create a consensus document. Four major content areas were addressed: What is a MET Response? Is there a MET syndrome? What are barriers to METS? How should outcome be measured? Panelists considered whether all hospitals should implement an RRS. RESULTS: Patients needing an RRS intervention are suddenly critically ill and have a mismatch of resources to needs. Hospitals should implement an RRS, which consists of four elements: an afferent, "crisis detection" and "Response triggering" mechanism; an efferent, predetermined Rapid Response Team; a governance/administrative structure to supply and organize resources; and a mechanism to evaluate crisis antecedents and promote hospital process improvement to prevent future events.

Robert Baute - One of the best experts on this subject based on the ideXlab platform.

  • the effect of a Rapid Response Team on major clinical outcome measures in a community hospital
    Critical Care Medicine, 2007
    Co-Authors: Michael J Dacey, Ehsun Raza Mirza, Virginia Wilcox, Maureen Doherty, James Mello, Amy Boyer, Jonathan D Gates, Robert Baute
    Abstract:

    Objective:To determine the effect of a Rapid Response system composed primarily of a Rapid Response Team led by physician assistants on the rates of in-hospital cardiac arrests, total and unplanned intensive care unit admissions, and hospital mortality.Design:Prospective, controlled, before and afte

  • the effect of a Rapid Response Team on major clinical outcome measures in a community hospital
    Critical Care Medicine, 2007
    Co-Authors: Michael J Dacey, Ehsun Raza Mirza, Virginia Wilcox, Maureen Doherty, James Mello, Amy Boyer, Jonathan D Gates, Robert Baute
    Abstract:

    OBJECTIVE: To determine the effect of a Rapid Response system composed primarily of a Rapid Response Team led by physician assistants on the rates of in-hospital cardiac arrests, total and unplanned intensive care unit admissions, and hospital mortality. DESIGN: Prospective, controlled, before and after trial. SETTING: A 350-bed nonteaching community hospital. PATIENTS: All adult patients admitted to the hospital from May 1, 2005, to October 1, 2006. INTERVENTIONS: We introduced a hospital-wide Rapid Response system that included a Rapid Response Team (RRT) led by physician assistants with specialized critical care training. MEASUREMENTS AND MAIN RESULTS: We measured the incidence of cardiac arrests that occurred outside of the intensive care unit, total intensive care unit admissions, unplanned intensive care unit admissions, intensive care unit length of stay, and the total hospital mortality rate occurring over the study period. There were 344 RRT calls during the study period. In the 5 months before the Rapid Response system began, there were an average of 7.6 cardiac arrests per 1,000 discharges per month. In the subsequent 13 months, that figure decreased to 3.0 cardiac arrests per 1,000 discharges per month. Overall hospital mortality the year before the Rapid Response system was 2.82% and decreased to 2.35% by the end of the RRT year. The percentage of intensive care unit admissions that were unplanned decreased from 45% to 29%. Linear regression analysis of key outcome variables showed strong associations with the implementation of the Rapid Response system, as did analysis of variables over time. Physician assistants successfully managed emergency airway situations without assistance in the majority of cases. CONCLUSIONS: The deployment of an RRT led by physician assistants with specialized skills was associated with significant decreases in rates of in-hospital cardiac arrest and unplanned intensive care unit admissions.

Daryl A Jones - One of the best experts on this subject based on the ideXlab platform.

  • Rapid Response Team review of hemodynamically unstable ward patients the accuracy of cardiac index assessment
    Journal of Critical Care, 2019
    Co-Authors: Christopher T Eyeington, Glenn M Eastwood, Patryck Lloyddonald, Matthew J Chan, Helen Young, Leah Peck, Daryl A Jones, Rinaldo Bellomo
    Abstract:

    Abstract Purpose Intensive care doctors commonly attend Rapid Response Team (RRT) reviews of hospital-ward patients with hemodynamic instability and estimate the patient’s likely cardiac index (CI). We aimed to non-invasively measure the CI of such patients and assess the level of agreement between such measurements and clinically estimated CI categories (low Materials and methods A prospective, observational study of non-invasive measurement and clinical estimation of CI categories in 50 adult hospital-ward patients who activated the RRT for ‘hemodynamic instability’ (tachycardia > 100BPM or hypotension Results The CI was measured in 47/50(94%) patients and the mean CI was 3.5(95% CI 3.2-3.7) L/min/m2. Overall, 30(64%) patients had a high CI, 13(28%) and 4(9%) had a normal and a low CI, respectively. The level of agreement between measured and clinically estimated CI categories was low(19.2%). Sensitivity and positive predictive values of clinical estimation were low(0% and 3.3% for high CI, and 0% and 50% for low CI, respectively). Conclusions Non-invasive CI measurement was possible in almost all hospital-ward patients triggering RRT review for hemodynamic instability. In such patients, the CI was high, and intensive care clinicians were unable to identify a low or a high CI state.

  • what nurses involved in a medical emergency Teams consider the most vital areas of knowledge and skill when delivering care to the deteriorating ward patient a nurse oriented curriculum development project
    Nurse Education Today, 2018
    Co-Authors: Judy Currey, Debbie Massey, Josh Allen, Daryl A Jones
    Abstract:

    Abstract Introduction Critical care nurses have been involved in Rapid Response Teams since their inception, particularly in medically led RRTs, known as Medical Emergency Teams. It is assumed that critical care skills are required to escalate care for the deteriorating ward patient. However, evidence to support critical care nurses' involvement in METs is anecdotal. Currently, little is known about the educational requirements for nurses involved in RRT or METs. Objectives We aimed to identify and describe what nurses involved in a MET consider the most vital areas of knowledge and skill when delivering care to the deteriorating ward patient. Methods An exploratory descriptive design was used and data was collected at a session of the Australian and New Zealand Intensive Care Society Rapid Response Team (ANZICS-RRT) Conference held at The Gold Coast, Australia in July 2015. All conference delegates were eligible to take part. Conference delegates totalled 293; 194 nurses, 89 doctors and 10 allied health professionals. Data collection took place in three phases, over a 90-minute period. First, demographic data were collected from all participants at the start of data collection. These data were collected using paper-based surveys. Second, extended Response surveys; that is, paper-based surveys that asked open-ended questions to elicit free text Responses, were used to collect participants' individual Responses to the question: “What are the specific theoretical knowledge, skills and behavioural attributes required in a curricula to prepare nurses to be high functioning members of a MET?” Demographic, educational and work characteristics were descriptively analysed using SPSS (version 22). Participants perceptions of what knowledge, skills and attributes are required for nurses to recognise and respond to clinical deterioration were thematically analysed. Results Participants were predominantly female (88.3%, n = 91) with 54.4% (n = 56) holding a Bachelor of Nursing. Participants had a median of 20 years (IQR 16) experience as RNs, and a median of 14 years (IQR 13) experience in critical care. Participants formed part of METs frequently, with nearly half the cohort seeing clinically deteriorating patients more than once per day (37.9%, n = 33) or daily (10%, n = 9). Thematic analysis of survey Responses revealed four main themes desired in Rapid Response Team Curricula: Clinical Deterioration Theory, Clinical Deterioration Skills, Rapid Response System Governance, and Professionalism and Teamwork. Conclusions We suggest that a curriculum that educates nurses on the specific requirements of assessing, managing and evaluating all aspects of clinical deterioration is now required.

  • patient physiological status during emergency care and Rapid Response Team or cardiac arrest Team activation during early hospital admission
    European Journal of Emergency Medicine, 2017
    Co-Authors: Julie Considine, Daryl A Jones, David Pilcher, Judy Currey
    Abstract:

    ObjectivesThe objective of this study was to examine the relationship between Rapid Response Team (RRT) or cardiac arrest Team (CAT) activation within 72 h of emergency admission and (i) physiological status in the emergency department (ED) and (ii) risk for ICU admission and in-hospital mortality.M

  • epidemiology of early Rapid Response Team activation after emergency department admission
    Australasian Emergency Nursing Journal, 2016
    Co-Authors: Juan Carlos Mora, Julie Considine, Daryl A Jones, Antoine G Schneider, Raymond J Robbins, Michael Bailey, Bronwyn Bebee, Yufeng Frank Hsiao, Rinaldo Bellomo
    Abstract:

    Summary Background Rapid Response Team (RRT) calls can often occur within 24h of hospital admission to a general ward. We seek to determine whether it is possible to identify these patients before there is a significant clinical deterioration. Methods Retrospective case–controlled study comparing patient characteristics, vital signs, and hospital outcomes in patients triggering RRT activation within 24h of ED admission (cases) with matched ED admissions not receiving a RRT call (controls). Results Over 12 months, there were 154 early RRT calls. Compared with controls, cases had a higher heart rate (HR) at triage (92 vs. 84beats/min; p =0.008); after 3h in the ED (91 vs. 80beats/min; p =0.0007); and at ED discharge (91 vs. 81beats/min; p =0.0005). Respiratory rate (RR) was also higher at triage (21.2 vs. 19.2breaths/min; p =0.001). On multiple variable analysis, RR at triage and HR before ward transfer predicted early RRT activation: OR 1.07 [95% CI 1.02–1.12] for each 1breath/min increase in RR; and 1.02 [95% CI 1.002–1.030] for each beat/minute increase in HR, respectively. Study patients required transfer to the intensive care in approximately 20% of cases and also had a greater mortality: (21% vs. 6%; OR 4.65 [95% CI 1.86–11.65]; p =0.0003) compared with controls. Conclusions Patients that trigger RRT calls within 24h of admission have a fourfold increase in risk of in-hospital mortality. Such patients may be identified by greater tachycardia and tachypnoea in the ED.

  • clinical review the role of the intensivist and the Rapid Response Team in nosocomial end of life care
    Critical Care, 2013
    Co-Authors: Andrew Hilton, Rinaldo Bellomo, Daryl A Jones
    Abstract:

    In-hospital end-of-life care outside the ICU is a new and increasing aspect of practice for intensive care physicians in countries where Rapid Response Teams have been introduced. As more of these patients die from withdrawal or withholding of artificial life support, determining whether a patient is dying or not has become as important to intensivists as the management of organ support therapy itself. Intensivists have now moved to making such decisions in hospital wards outside the boundaries of their usual closely monitored environment. This strategic change may cause concern to some intensivists; however, as custodians of the highest technology area in the hospital, intensivists are by necessity involved in such processes. Now, more than ever before, intensive care clinicians must consider the usefulness of key concepts surrounding nosocomial death and dying and the importance and value of making a formal diagnosis of dying in the wards. In this article, we assess the conceptual background, reference points, challenges and implications of these emerging aspects of intensive care medicine.

Julie Considine - One of the best experts on this subject based on the ideXlab platform.

  • characteristics and outcomes of emergency interhospital transfers from subacute to acute care for clinical deterioration
    International Journal for Quality in Health Care, 2019
    Co-Authors: Julie Considine, Maryann Street, Helen Rawson, Anastasia F. Hutchison, Tracey Bucknall
    Abstract:

    Objective: To describe characteristics and outcomes of emergency interhospital transfers from subacute to acute hospital care and develop an internally validated predictive model to identify features associated with high risk of emergency interhospital transfer. Design: Prospective case-time-control study. Setting: Acute and subacute healthcare facilities from five health services in Victoria, Australia. Participants: Cases were patients with an emergency interhospital transfer from subacute to acute hospital care. For every case, two inpatients from the same subacute care ward on the same day of emergency transfer were randomly selected as controls. Admission episode was the unit of measurement and data were collected prospectively. Main outcome measures: Patient and admission characteristics, transfer characteristics and outcomes (cases), serious adverse events and mortality. Results: Data were collected for 603 transfers in 557 patients and 1160 control patients. Cases were significantly more likely to be male, born in a non-English speaking country, have lower functional independence, more frequent vital sign assessments and experience a serious adverse event during first acute care or subacute care admissions. When adjusted for health service, cases had significantly higher inpatient mortality, were more likely to have unplanned intensive care unit admissions and Rapid Response Team calls during their entire hospital admission. Conclusions: Patients who require an emergency interhospital transfer from subacute to acute hospital care have hospital admission rates and in-hospital mortality. Clinical instability during the first acute care admission (serious adverse events or increased surveillance) may prompt reassessment of patient suitability for movement to a separate subacute care hospital.

  • patient physiological status during emergency care and Rapid Response Team or cardiac arrest Team activation during early hospital admission
    European Journal of Emergency Medicine, 2017
    Co-Authors: Julie Considine, Daryl A Jones, David Pilcher, Judy Currey
    Abstract:

    ObjectivesThe objective of this study was to examine the relationship between Rapid Response Team (RRT) or cardiac arrest Team (CAT) activation within 72 h of emergency admission and (i) physiological status in the emergency department (ED) and (ii) risk for ICU admission and in-hospital mortality.M

  • epidemiology of early Rapid Response Team activation after emergency department admission
    Australasian Emergency Nursing Journal, 2016
    Co-Authors: Juan Carlos Mora, Julie Considine, Daryl A Jones, Antoine G Schneider, Raymond J Robbins, Michael Bailey, Bronwyn Bebee, Yufeng Frank Hsiao, Rinaldo Bellomo
    Abstract:

    Summary Background Rapid Response Team (RRT) calls can often occur within 24h of hospital admission to a general ward. We seek to determine whether it is possible to identify these patients before there is a significant clinical deterioration. Methods Retrospective case–controlled study comparing patient characteristics, vital signs, and hospital outcomes in patients triggering RRT activation within 24h of ED admission (cases) with matched ED admissions not receiving a RRT call (controls). Results Over 12 months, there were 154 early RRT calls. Compared with controls, cases had a higher heart rate (HR) at triage (92 vs. 84beats/min; p =0.008); after 3h in the ED (91 vs. 80beats/min; p =0.0007); and at ED discharge (91 vs. 81beats/min; p =0.0005). Respiratory rate (RR) was also higher at triage (21.2 vs. 19.2breaths/min; p =0.001). On multiple variable analysis, RR at triage and HR before ward transfer predicted early RRT activation: OR 1.07 [95% CI 1.02–1.12] for each 1breath/min increase in RR; and 1.02 [95% CI 1.002–1.030] for each beat/minute increase in HR, respectively. Study patients required transfer to the intensive care in approximately 20% of cases and also had a greater mortality: (21% vs. 6%; OR 4.65 [95% CI 1.86–11.65]; p =0.0003) compared with controls. Conclusions Patients that trigger RRT calls within 24h of admission have a fourfold increase in risk of in-hospital mortality. Such patients may be identified by greater tachycardia and tachypnoea in the ED.

Hermano Alexandre Lima Rocha - One of the best experts on this subject based on the ideXlab platform.

  • dealing with the impact of the covid 19 pandemic on a Rapid Response Team operation in brazil quality in practice
    International Journal for Quality in Health Care, 2021
    Co-Authors: Hermano Alexandre Lima Rocha, Antonia Celia De Castro Alcântara, Fernanda Colares De Borba Netto, Flavio Lucio Pontes Ibiapina, Livia Amaral Lopes, Sabrina Gabriele Maia Oliveira Rocha, Elias Bezerra Leite
    Abstract:

    QUALITY PROBLEM OR ISSUE Up to 13 July 2020, >12 million laboratory-confirmed cases of coronavirus disease of 2019 (COVID-19) infection have been reported worldwide, 1 864 681 in Brazil. We aimed to assess an intervention to deal with the impact of the COVID-19 pandemic on the operations of a Rapid Response Team (RRT). INITIAL ASSESSMENT An observational study with medical record review was carried out at a large tertiary care hospital in Fortaleza, a 400-bed quaternary hospital, 96 of which are intensive care unit beds. All adult patients admitted to hospital wards, treated by the RRTs during the study period, were included, and a total of 15 461 RRT calls were analyzed. CHOICE OF SOLUTION Adequacy of workforce sizing. IMPLEMENTATION The hospital adjusted the size of its RRTs during the period, going from two to four simultaneous on-duty medical professionals. EVALUATION After the beginning of the pandemic, the number of treated cases in general went from an average of 30.6 daily calls to 79.2, whereas the extremely critical cases went from 3.5 to 22 on average. In percentages, the extremely critical care cases went from 10.47 to 20%, with P < 0.001. Patient mortality remained unchanged. The number of critically ill cases and the number of treated patients increased 2-fold in relation to the prepandemic period, but the effectiveness of the RRT in relation to mortality was not affected. LESSONS LEARNED The observation of these data is important for hospital managers to adjust the size of their RRTs according to the new scenario, aiming to maintain the intervention effectiveness.