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Background: Research continues to be conducted on rapid response systems as patient outcomes associated with rapid response team activations are still not consistently showing benefit. One particular area of focus that is a growing area is the literature regarding training and education for individual team members of the rapid response team. Objective: The purpose of this narrative review was to describe the current literature regarding educational interventions for rapid response team members. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. To be included in the narrative review, studies needed to be reporting on educational interventional research for rapid response team members of the efferent limb. No studies were excluded based upon study design or publication years. Results: This narrative reviewincluded 6 studies. Four studies assessed outcomes associated with rapid response team members, and 2 of the studies assessed patient outcomes associated with implementing education routinely for rapid response teams. All studies found a positive impact of implementing educational interventions. Discussion: Our narrative review found that limited research has been conducted in the area of educational interventions for rapid response team members, and of the articles identified, most did not assess patient-associated outcomes. The findings demonstrate that this area of research is in its early stages, and further work is needed to identify what content should be provided in the education and what educational methodologies should be employed, and to continue to assess patient health outcomes associated with educational interventions for rapid response team members. [ABSTRACT FROM AUTHOR]

Sepsis carries a high mortality in the United States. Hospitals across the country are working to find new ways to recognize, treat, and streamline care for patients with sepsis. At an academic medical center in the Midwest, a quality improvement project was developed using a sepsis rapid response team with physician associates/assistants (PAs) and NPs. This improved hospital adherence to sepsis evaluation and order set use from 48% to 86%. The added evaluation of the patient by a PA or NP, along with ensuring adherence to the sepsis order set, made an effective first step to improve care of patients with sepsis in this hospital. [ABSTRACT FROM AUTHOR]

Background: General patient acuity is increasing in the United States, with more patients having multiple comorbidities and acute-on-chronic conditions. Hospitalizations may also be complicated by serious adverse events, often unrelated to the admitting medical diagnosis. In our facility, the late detection of patient deterioration on general medical units often resulted in increased length of stay (LOS) in the ICU and poor patient outcomes. Purpose: The purpose of this project was to improve patient surveillance and better identify early signs of patient deterioration through the use of continuous vital sign monitoring technology. Methods: To improve detection of patient deterioration, a nurse-led monitoring and response system was developed using a wearable, wireless device for continuous vital sign surveillance. The patient data the device provided was used with early warning scores and sepsis screening protocols for timely goal-directed interventions. Results: Ninety-seven percent of patient deterioration events were recognized and treated as a result of this continuous monitoring and response system. Rapid response team activations decreased by 53% between baseline and the intervention period. LOS among patients transferred to the ICU decreased from 2.82 to 2.19 days. Nurse satisfaction with use of the continuous monitoring device was positive, with 74% of nurses surveyed reporting that information provided by the device enhanced decision-making. Conclusions: New technology for patient surveillance, in this case a nurse-led monitoring and response system, can be successfully integrated into general care practice. Use of the nurse-led response system helped nurses recognize early signs of deterioration and continue meaningful patient interactions. [ABSTRACT FROM AUTHOR]

Background: Inpatient nurses identified the need to recognize clinical deterioration earlier, including rapid response team (RRT) activations and transfers to the intensive care unit. Surveys identified the need for better interdisciplinary communication. Local Problem: A system was needed to detect early clinical deterioration with structured responses promoting multidisciplinary collaboration. Methods: An early warning score (EWS) identified patients at risk. The system ensured timely and accurate actions were taken when scores reached 3 or above. Interventions: Collaborative, graded responses to EWSs and nurse-led rounds promoted communication and timely interventions. Results: Mortality decreased (-27%) as did multiple RRT activations on a single patient (-15%). Nurses are aware of early vital sign changes (+45%) and resident responsiveness has improved. There has been an increase in nurse/resident communication satisfaction (+31%). Conclusions: The system implemented reinforces the importance of patient assessment, collaboration among the multidisciplinary team, and promotes early interventions. [ABSTRACT FROM AUTHOR]

The purpose of this literature review was to investigate the major barriers nurses face when it is necessary to seek additional assistance and resources by calling the rapid response team (RRT) in order to manage and stabilize a clinically deteriorating patient. A total of 40 articles were reviewed. Eight barriers were identified as having an impact on RRT activation, either causing a delay in activation time or preventing activation altogether: a lack of consistent RRT education among nurses, the established hierarchy in the hospital, an uncertainty about when to call the RRT if clinical deterioration is subtle or gradual rather than abrupt, a perceived need to justify a decision to call the RRT, the increased workload for both the ICU nurse and the medical-surgical nurse, negative past experiences with RRTs, an unsupportive unit culture, and less nursing experience. Suggestions for overcoming these barriers include RRT education for nurses and physicians in addition to fostering a supportive unit culture. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate what proportion of unplanned ICU admissions from hospital wards occurred after rapid response team review and compare baseline characteristics and outcomes of patients admitted after rapid response team review with non-rapid response team-related admissions.Design: Multicenter binational retrospective cohort study.Setting: One-hundred seventy-eight ICUs across Australia and New Zealand.Patients: All adults (≥ 17 yr) in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2012 and 2017.Interventions: None.Measurements and Main Results: Among 97,181 unplanned ICU admissions from the ward, prior rapid response team review occurred in 55,084 cases (56.7%). Rapid response team patients were slightly older (65.4 [16.9] vs 63.3 [18]), had a higher Acute Physiology and Chronic Health Evaluation III score (64.6 [27.1] vs 54.7 [25.3]) and more frequently had limitations of medical treatment (13.1% vs 8.5%) compared with patients with no rapid response team review. The strongest independent associations with ICU admission following rapid response team review included age, ICU admission diagnosis (especially sepsis-, neurologic-, respiratory-, and cardiovascular-related), tertiary ICU status, and presence of limitations of medical treatment (p < 0.0001 all comparisons). Rapid response team-related ICU admissions had a longer median ICU (2.4 d [1.2-4.6 d] vs 2.1 d [1.0-4.2 d]) and hospital (12.8 d [7.0-23.6 d] vs 10.8 d [5.9-20.3 d]) length of stay, and were more likely to die in the ICU (12.3% vs 7.5%) and in-hospital (20.8% vs 13.5%) (p < 0.0001). After adjusting for illness severity and institution, patients admitted following rapid response team review stayed longer in hospital but were not at increased risk of dying in-hospital (adjusted odds ratio, 1.03; 0.98-1.07).Conclusions: In Australia and New Zealand, hospital ward patients admitted to ICU following rapid response team review represent the majority of ward-based ICU admissions, are more chronically and acutely ill, and more frequently have sepsis than those admitted from the ward without rapid response team review. Their unadjusted outcomes are worse, but after adjustment their mortality is similar. [ABSTRACT FROM AUTHOR]

All clinical nurses need to be prepared to recognize deterioration in a patient's clinical status and activate the rapid response team when appropriate. This article explores the clinical nurse's role in recognizing and responding to deterioration in a patient's condition with a focus on hospital-based nurses practicing on a medical-surgical unit. [ABSTRACT FROM AUTHOR]

Background: Rapid Response Systems are emerging internationally to provide a patient-focused approach to prevent potentially avoidable deaths and serious adverse events. Local Problem: This study focused on ward nurses in the United Arab Emirates (UAE) government hospitals who were perceived to lack the confidence and knowledge to detect and/or respond to deteriorating patients. Method: A cross-sectional study design was used to evaluate the Intensive Care Outreach Nurse (ICON) role from the perspectives of the ICONs, their managers/educators, and ward-based physicians and nurses. ICONs are intensive care experienced nurses with additional education in the role of rapid responder to the deteriorating patient. Interventions: An ICON role was implemented across 4 hospitals to respond to and support clinicians in the recognition and management of the deteriorating patient on general inpatient wards. Results: ICON skills perceived as most beneficial by respondents included staff education, respiratory therapy, medication administration, and intravenous access. Conclusions: The ICON role is able to support recognition and management of the deteriorating patients. [ABSTRACT FROM AUTHOR]

Background: Operationalization of the rapid response team (RRT) and its quality champion (QC) nurses at a community hospital is unique and provides benefits not entirely captured by analysis of mortality data. Purpose: The purpose was to determine the perceived benefits of the RRT at the facility and behaviors and activities observed during actual RRT responses. Also examined was the timeliness of the RRT calls. Methods: This was a mixed-method study including qualitative (interviews, focus groups, and surveys) and quantitative (retrospective chart reviews) data collection. Results: Themes included teaching/education, foster development of critical thinking skills, expertise/ resource, communication/facilitation/go-between, safety net/security, validation, and advocate/foster collaboration. RRT calls were made quickly after clinical deterioration. Conclusions: Benefits of the RRT-QC registered nurse were extensive. Observations showed support, education, and teamwork in an effort to improve outcomes and support clinicians. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether a national standard for improving care of deteriorating patients affected ICU admissions following cardiac arrests from hospital wards. Design: Retrospective study assessing changes from baseline (January 1, 2008, to June 30, 2010), rollout (July 1, 2010, to December 31, 2012), and after (January 1, 2013, to 31 December 31, 2014) national standard introduction. Conventional inferential statistics, interrupted time series analysis, and adjusted hierarchical multiple logistic regression analysis. Setting: More than 110 ICU-equipped Australian hospitals. Patients or Subjects: Adult patients (≥ 18 yr old) admitted to participating ICUs. Interventions: Introducing a national framework to improve care of deteriorating patients including color-coded observation charts, mandatory rapid response system, enhanced governance, and staff education for managing deteriorating patients. Measurements and Main Results: Cardiac arrest–related ICU admissions from the ward decreased from 5.6% (baseline) to 4.9% (rollout) and 4.1% (intervention period). Interrupted time series analysis revealed a decline in the rate of cardiac arrest– related ICU admissions in the rollout period, compared with the baseline period (p = 0.0009) with a subsequent decrease in the rate in the intervention period (p = 0.01). Cardiac arrest–related ICU admissions were less likely in the intervention period compared with the baseline period (odds ratio, 0.85; 95% CI, 0.78– 0.93; p = 0.001), as was in-hospital mortality from cardiac arrests (odds ratio, 0.79; 95% CI, 0.65–0.96; p = 0.02). Conclusions: Introducing a national standard to improve the care of deteriorating patients was associated with reduced cardiac arrest–related ICU admissions and subsequent in-hospital mortality of such patients. [ABSTRACT FROM AUTHOR]

Rapid response teams (RRTs) were implemented to provide critical care services for deteriorating patients outside of intensive care units. To date, research on RRT has been conflicting, with some studies showing significant mortality benefit and reduction in cardiac arrest events and others showing no benefit. However, studies have consistently showed improved outcomes when RRTs work closely with primary services. Baseline data analysis at our institution found that primary services were present only on 50% of RRT activations. This quality improvement project aimed to improve the presence of primary services during RRT activations by 25%. With a survey, the main barrier that prevented primary services to be present was identified as the primary services' failure to recognize them as a crucial part of the RRT. Education tools and in-person sessions were implemented reinforcing the importance of primary services presence during RRT activations. The intervention leads to increasing presence of primary services at RRT activations, transfers to higher level of care, and changes in code status. However, there was no difference in hospital or intensive care unit length of stay or in survival. [ABSTRACT FROM AUTHOR]

Objectives: Decreased staffing at nighttime is associated with worse outcomes in hospitalized patients. Rapid response teams were developed to decrease preventable harm by providing additional critical care resources to patients with clinical deterioration. We sought to determine whether rapid response team call frequency suffers from decreased utilization at night and how this is associated with patient outcomes.Design: Retrospective analysis of a prospectively collected registry database.Setting: National registry database of inpatient rapid response team calls.Patients: Index rapid response team calls occurring on the general wards in the American Heart Association Get With The Guidelines-Medical Emergency Team database between 2005 and 2015 were analyzed.Interventions: None.Measurements and Main Results: The primary outcome was inhospital mortality. Patient and event characteristics between the hours with the highest and lowest mortality were compared, and multivariable models adjusting for patient characteristics were fit. A total of 282,710 rapid response team calls from 274 hospitals were included. The lowest frequency of calls occurred in the consecutive 1 AM to 6:59 AM period, with 266 of 274 (97%) hospitals having lower than expected call volumes during those hours. Mortality was highest during the 7 AM hour and lowest during the noon hour (18.8% vs 13.8%; adjusted odds ratio, 1.41 [1.31-1.52]; p < 0.001). Compared with calls at the noon hour, those during the 7 AM hour had more deranged vital signs, were more likely to have a respiratory trigger, and were more likely to have greater than two simultaneous triggers.Conclusions: Rapid response team activation is less frequent during the early morning and is followed by a spike in mortality in the 7 AM hour. These findings suggest that failure to rescue deteriorating patients is more common overnight. Strategies aimed at improving rapid response team utilization during these vulnerable hours may improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Understanding how an organization determines structure and function of a rapid response team (RRT), as well as cost evaluation and implications, can provide foundational knowledge to guide decisions about RRTs. Objectives: The objectives were to (1) identify influencing factors in organizational development of RRT structure and function and (2) describe evaluation of RRT costs. Methods: Using a qualitative, ethnographic design, nurse executives and experts in 15 moderate-size hospitals were interviewed to explore their decision-making processes in determining RRT structure and function. Face-to-face interviews were audio recorded and transcribed verbatim and verified for accurateness. Using content analysis and constant comparison, interview data were analyzed. Demographic data were analyzed using descriptive statistics. Results: The sample included 27 participants from 15 hospitals in 5 south-central states. They described a variety of RRT responders and functions, with the majority of hospitals having a critical care charge nurse attending all RRT calls for assistance. Others described a designated RRT nurse with primary RRT duties as responder to all RRT calls. Themes of RRT development from the data included influencers, decision processes, and thoughts about cost. Discussion: It is important to understand how hospitals determine optimal structure and function to enhance support of quality nursing care. Determining the impact of an RRT on costs and benefits is vital in balancing patient safety and limited resources. Future research should focus on clarifying differences between team structure and function in outcomes as well as the most effective means to estimate costs and benefits. [ABSTRACT FROM AUTHOR]

Rapid response team (RRT) adoption and implementation are associated with improved quality of care of patients who experience an unanticipated medical emergency. The sustainability of RRTs is vital to achieve long-term benefits of these teams for patients, staff, and hospitals. Factors required to achieve RRT sustainability remain unclear. This study examined the relationship between sustainability elements and RRT sustainability in hospitals that have previously implemented RRTs. [ABSTRACT FROM AUTHOR]

At our institution, we recognized a need for a standardized, efficient approach to safely evaluate, prepare, and transport patients in need of emergent surgery. With the establishment of an Emergency Surgery Transport and Assessment Team, we were able to substantially reduce our median transport time to the OR. We believe other institutions can establish an efficient team using existing resources to expedite care of the emergent surgical patient. [ABSTRACT FROM AUTHOR]

Despite the addition of family-activated rapid response to the rapid response team algorithm, a children's hospital did not see an increase in utilization of the pediatric rapid response team. A Pediatric Early Warning Score in non-ICU pediatric inpatient units was implemented to increase the number of rapid response team activations. A retrospective review of the 130-bed facility, over a 12-month period, revealed an increase in pediatric rapid response calls, with a subsequent decrease in code team activations. The authors outline implementation strategies and discuss barriers encountered throughout the process, along with implications for nurse leaders. [ABSTRACT FROM AUTHOR]

To determine the level of sustainability of rapid response teams (RRTs) among a group of hospitals that participated in a statewide collaborative to implement and sustain RRTs.~Objectives~Objective~Fifty-six hospitals located in a southeastern state in the United States participated in a statewide 9-month collaborative that provided organization leaders with resources to implement and sustain RRTs. Thirty-three of these hospitals completed the electronic survey. Two hospitals were excluded because of missing data.~Setting and Sample~Methods~The RRT-Institutionalization Scale (RRT-IS), adapted from the Level of Institutionalization Scale, measured the degree of institutionalization (i.e., passages, routines, and niche saturation) across four subsystems: production, maintenance, supportive, and managerial.~Measurement~Methods~Thirty-one hospitals participated (response rate 55%). Rapid response team sustainability levels ranged from 1.0 to 5.98 (mean = 3.78, 95% CI = 3.40-4.17). The highest sustainability score was reported in the managerial subsystem (median = 5.3, IQR = 4.5-7.33), and the lowest score was reported in the supportive subsystem (median = 1.0, IQR = 1.0-2.0).~Results~Results~Rapid response team sustainability levels varied across hospitals in the collaborative. Different levels of sustainability were also observed across organizational subsystems. The lack of resources, staff, and dedicated funds hampered organizations' sustainability efforts.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Background: The perceived benefits of rapid response teams (RRTs) influence whether RRTs are used and sustained. Perceived benefits are particularly important to sustaining RRTs when limited RRT data are shared with organizational members. Nurse leaders' perceptions of the benefits of RRTs likely influence their support, which is crucial for sustained RRT use. The perceptions of RRT members and end users similarly will affect use. But little is known regarding the perceptions of nurse leaders, RRT members, and RRT users in this regard. Objective: This study sought to explore and compare the perceptions of nurse leaders, RRT members, and RRT users regarding the benefits of RRTs. Methods: A qualitative, multiple-case study design was used. Semistructured interviews were conducted with nurse leaders, RRT members, and RRT users at four community hospitals, as part of a larger mixed-methods study examining RRT sustainability. Purposive and snowball sampling were used. Recruitment strategies included e-mail and listserv announcements, on-site presentations, direct personal contact, and a study flyer. Results: All participants reported perceiving various ways that RRTs benefit the organization, staff members, and patients. Variations in the benefits perceived were observed between the three participant groups. Nurse leaders' perceptions tended to focus on macro-level benefits. RRT members emphasized the teaching and learning opportunities that RRTs offer. RRT users focused on the psychological support that RRTs can provide. Conclusions: Both similarities and differences were found between nurse leaders, RRT members, and RRT users regarding their perceptions of RRT benefits. Differences may be indicative of organizations' information-sharing processes; of variation in the priorities of nurse leaders, RRT members, and RRT users; and of the challenges nurses face daily in their work environments. Future research should investigate whether the perceived benefits of RRTs are borne out in actuality, as well as the relationships between the perceived benefits of RRTs and organizational and RRT characteristics. [ABSTRACT FROM AUTHOR]

Objective: To identify whether delays in rapid response team activation contributed to worse patient outcomes (mortality and morbidity).Design: Retrospective observational cohort study including all rapid response team activations in 2012.Setting: Tertiary academic medical center.Patients: All those 18 years old or older who had a rapid response team call activated. Vital sign data were abstracted from individual patient electronic medical records for the 24 hours before the rapid response team activation took place. Patients were considered to have a delayed rapid response team activation if more than 1 hour passed between the first appearance in the record of an abnormal vital sign meeting rapid response team criteria and the activation of an rapid response team.Interventions: None.Measurements and Main Results: A total of 1,725 patients were included in the analysis. Data were compared between those who had a delayed rapid response team activation and those who did not. Fifty seven percent patients met the definition of delayed rapid response team activation. Patients in high-frequency physiologic monitored environments were more likely to experience delay than their floor counterparts. In the no-delay group, the most common reasons for rapid response team activation were tachycardia/bradycardia at 29% (217/748), respiratory distress/low SpO2 at 28% (213/748), and altered level of consciousness at 23% (170/748) compared with respiratory distress/low SpO2 at 43% (423/977), tachycardia/bradycardia at 33% (327/977), and hypotension at 27% (261/977) in the delayed group. The group with no delay had a higher proportion of rapid response team calls between 8:00 and 16:00, whereas those with delay had a higher proportion of calls between midnight and 08:00. The delayed group had higher hospital mortality (15% vs 8%; adjusted odds ratio, 1.6; p = 0.005); 30-day mortality (20% vs 13%; adjusted odds ratio, 1.4; p = 0.02); and hospital length of stay (7 vs 6 d; relative prolongation, 1.10; p = 0.02) compared with the no-delay group.Conclusions: Delays in rapid response team activation occur frequently and are independently associated with worse patient mortality and morbidity outcomes. [ABSTRACT FROM AUTHOR]

Objective: To describe the effect of implementation of a rapid response system on the composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death.Design: Pragmatic prospective Dutch multicenter before-after trial, Cost and Outcomes analysis of Medical Emergency Teams trial.Setting: Twelve hospitals participated, each including two surgical and two nonsurgical wards between April 2009 and November 2011. The Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments were implemented over 7 months. The rapid response team was then implemented during the following 17 months. The effects of implementing the rapid response team were measured in the last 5 months of this period.Patients: All patients 18 years old and older admitted to the study wards were included.Measurements and Main Results: In total, 166,569 patients were included in the study representing 1,031,172 hospital admission days. No differences were observed in patient demographics between periods. The composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death per 1,000 admissions was significantly reduced in the rapid response team versus the before phase (adjusted odds ratio, 0.847; 95% CI, 0.725-0.989; p = 0.036). Cardiopulmonary arrests and in-hospital mortality were also significantly reduced (odds ratio, 0.607; 95% CI, 0.393-0.937; p = 0.018 and odds ratio, 0.802; 95% CI, 0.644-1.0; p = 0.05, respectively). Unplanned ICU admissions showed a declining trend (odds ratio, 0.878; 95% CI, 0.755-1.021; p = 0.092), whereas severity of illness at the moment of ICU admission was not different between periods.Conclusions: In this study, introduction of nationwide implementation of rapid response systems was associated with a decrease in the composite endpoint of cardiopulmonary arrests, unplanned ICU admissions, and mortality in patients in general hospital wards. These findings support the implementation of rapid response systems in hospitals to reduce severe adverse events. [ABSTRACT FROM AUTHOR]

Objective: We tested the hypothesis that responses to physiologic deterioration in hospital ward patients delayed by more than 15 minutes are associated with increased mortality.Design, Setting, and Participants: We used data from a 23-hospital cluster randomized trial (January 2004 to December 2004) of implementation of rapid response teams (intervention) versus standard practice with conventional cardiac arrest team-based responses to emergencies (control). We examined emergency calls in all hospitals. In intervention hospitals, we also examined such calls in the period before, during the introduction, and after the full implementation of a rapid response system. We studied the statistical association between such delayed calls and mortality.Main Outcomes and Measures: Hospital outcomes (mortality, unplanned ICU admissions, and cardiac arrests).Results: There were 3,135 emergency team calls in all hospitals. Overall, almost one third of such calls were delayed. In intervention hospitals, the proportion of delayed calls was similar before and after implementation of rapid response teams. Compared with control hospitals, in intervention hospitals, there was a significant decrease in the proportion of delayed calls during both the introduction (27.3% vs 34.3% weekly rate; incidence rate ratio, 0.84; p = 0.001) and the full implementation period (29.0% vs 34.5% weekly rate; incidence rate ratio, 0.84; p = 0.023). Delayed calls more likely occurred at night, in high dependence or coronary care units, in patients older than 75 years, in those with a decrease in Glasgow Coma Scale, or in those with hypotension as the reason for the call. Finally, in all hospitals, delayed calls were associated with an increased risk of unplanned ICU admissions (adjusted odds ratio = 1.56; 95% CI, 1.23-2.04; p ≤ 0.001) and death (adjusted odds ratio = 1.79; 95% CI, 1.43-2.27; p < 0.001).Conclusions: Among ward patients, emergency team activation in response to acute deterioration triggered more than 15 minutes after detection and documentation of instability is independently associated with an increased risk of ICU admission and death. [ABSTRACT FROM AUTHOR]

Objectives: Intraosseous access is a rapid and effective route of fluid and drug administration. Its use has been proven in emergency medicine, pediatrics, and the military. We aimed to assess its performance and utilization against landmark-guided central venous catheter placement during inpatient medical emergencies. Design: Prospective observational study. Setting: Eight hundred fifty-six-bed urban teaching hospital. Patients: Adult inpatients requiring central venous access during medical emergencies. Interventions: Intraosseous device training was added to standard central venous catheter training beginning in February 2012. Intraosseous were used as primary access in cardiac arrests and secondary access if central venous catheter placement failed during noncardiac arrest emergencies. An online survey was conducted among intraosseous and central venous catheter operators to assess their experience and any barriers to use. Measurements and Main Results: Seventy-nine adults had central access placement from February 2012 to July 2013. Sixty were during medical emergency team calls, and 19 were cardiac arrests. Thirty-one received intraosseous device, and 48 received a central venous catheter. First-pass success was significantly higher for intraosseous than for central venous catheter (90.3 vs 37.5%; 95% CI, 80-101 vs 24-51; p < 0.001). Mean placement times were significantly shorter for intraosseous than for central venous catheter (1.2 vs 10.7 min; p < 0.001). There were a total of 33 intraosseous versus 169 central venous catheter attempts with fewer attempts on average per patient during intraosseous placement (1.1 vs 2.8; p < 0.001). There were three intraosseous- related complications and 22 central venous catheter-related complications. Our survey showed high satisfaction with intraosseous training and operation. Among the barriers cited, timely intraosseous kit acquisition was most common. Conclusions: It is feasible to incorporate intraosseous use during medical emergency team calls. Intraosseous had significantly higher first-pass success rates and faster placement compared with central venous catheters. Intraosseous operators reported high satisfaction and confidence in its use. Prospective randomized studies comparing intraosseous and central venous catheter are warranted. [ABSTRACT FROM AUTHOR]

Background:The goal of rapid response team (RRT) activation in acute care facilities is to decrease mortality from preventable complications, but such efforts have been only moderately successful. Although recent research has shown decreased mortality when RRTs are activated more often, many hospitals have low activation rates.This has been linked to various hospital, team , and nursing factors. Yet there is a dearth of research examining how hospital systems shape nurses' behavior with regard to RRT activation. Making systemic constraints visible and modifying them may be the key to improving RRT activation rates and saving more lives. Purpose: The purpose of this study was to use cognitive work analysis to describe factors with in the hospital system that shape medical -surgical nurses' RRT activation behavior. Methods: Cognitive work analysis offers a framework for the study of complex sociotechnical systems. This framework was used as the organizing element of the study. Qualitative descriptive design was used to obtain data to fill the framework's five domains: resources, tasks, strategies, social systems, and worker competency. Data were obtained from interviews with 12 medical-surgical nurses and document review. Directed content analysis was used to place the obtained data in to the framework's predefined domains. Results: Many system factors affected participants'decisions to activate or not activate an RRT. Systemic constraints, especially in cases of subtle or gradual clinical changes, included a lack of adequate information, the availability of multiple strategies, the need to justify RRT activation, a scarcity of hum an resources, and informal hierarchical norms in the hospital culture. The most profound constraint was the need to justify the call. Justification was based on the objective or subjective nature of clinical changes, whether the nurse expected to be able to "handle" these changes, the presence or absence of a physician, and whether there was an expectation of support from the RRT team. The need for justification led to delays in RRT activation. Conclusions: Although it's generally thought that RRTs are activated without hesitation, this study found the opposite was true. All of the aforementioned constraints increase the cognitive processing load on the nurse. The value of the RRT could be increased by modifying these constraints— in particular, by lifting the need to justify calls, improving protocols, and broadening the range of culturally acceptable triggers— and by involving the RRT earlier inpatient cases through discussion, consultation, and collaboration. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship between implementation of rapid response teams and improved mortality rate using a large, uniform dataset from one state in the United States. Design: This observational cohort study included 471,062 adult patients hospitalized between 2001 and 2009. Setting: Ten acute tertiary care hospitals in Washington State. Patients or Other Participants: Hospital abstract records on adult patients (18 years old or older) were examined (n = 471,062). Patients most likely to benefit from rapid response team interventions were included and other prognostic factors of severity of illness and comorbidities were controlled. Each participating hospital provided the implementation date of their rapid response team intervention. Mortality rates in 31 months before rapid response team implementation (pre-rapid response team time period) were compared with mortality rates in 31 months following rapid response team implementation (post-rapid response team time period). Intervention(s): Implementation of a rapid response team within each acute tertiary care hospital. Measurements and Main Results: In-hospital mortality. Relative risk for in-hospital mortality improved in the post-rapid response team time period compared with the pre-rapid response team time period (relative risk = 0.76; 95% Cl = 0.72-0.80; p < 0.001). Conclusions: In-hospital mortality improved in six of 10 acute tertiary care hospitals in the post-rapid response team time period when compared with the pre-rapid response team time period. Because of a long-term trend of decline in hospital mortality, these decreases could not be unambiguously attributed to rapid response team implementation. Further research should examine additional objective outcomes and optimal configuration of rapid response teams to maximize intervention effectiveness. [ABSTRACT FROM AUTHOR]

It is incumbent for health care professionals to identify and reduce risk of harm. Left unchecked, minor risk may progress to increased care needs and subsequent morbidity. Recognizing nursing's front-line impact, a nursing clinical peer review committee was developed in an acute care hospital to analyze retrospectively select patient cases for opportunities to reduce risk in future similar situations. Risk-adjusted mortality and code blue calls decreased. [ABSTRACT FROM AUTHOR]

The article offers information on the pilot project training in nursing-focused crew resource management launched by the healthcare organization National Center for Patient Safety of the U.S. Veterans Health Administration (VHA) in 2010. It reports that crew resource management that was advised by the Institute of Medicine in 2000 to be implemented by the health care organizations enhance safety of patients and helps to communicate clinical information more effectively by nurses.

The article presents a study which explored intensive care unit (ICU) patients' characteristics and outcome based on admittance mode through conventional contact or rapid response team. Participants include 694 admissions from general wards to ICU. Results showed the importance of rapid response team in the identification of complex patients.

The article analyzes the impact of an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality. The rapid response team function is presented to be extended to include follow-up until clinical stabilization, and mandatory post-intensive care unit (ICU) follow-up. Non-ICU cardiopulmonary arrests, and total hospital mortality are revealed to have decreased following implementation.

The article explores whether a rapid-response system that depended on a patient's usual care providers, not a critical-care rapid-response team, would enhance patient outcomes. Results suggest that a primary-team-based implementation of a rapid response system was independently related to reduced unexpected mortality. This system allegedly relied on the patient's usual care providers. This system may also offer a more cost-effective strategy to rapid response systems.

The article discusses a study which examined the use of electronic automated advisory vital signs to monitor general hospital wards. The study included 18,305 patients at 12 general wards in 10 hospitals in the U.S., Europe and Australia. Study authors concluded that the use of electronic automated advisory vital signs monitors can improve rapid response team-calls due to respiratory criteria.

The article presents research findings into how nurses feel about rapid response teams. Interviews were conducted with hospital nurses. Nurses expressed appreciation for the availability of such teams to expedite patient care. Drawbacks of rapid response teams included mixed messages regarding when to activate the team.

The article presents a study on the perception of registered nurses (RNs) and general surgery residents regarding the impact of medical emergency (MET) team on their educational experiences and safety of patients. It cites that a survey was conducted among 497 RNs and 141 internal medicine and general surgery residents. The results show that the notion of RNs and residents on the impact of MET to patient safety has improved without important educational or skills compromise.

The article evaluates the association between early emergency team calls and the incidence of serious adverse events in a cluster randomized controlled trial of medical emergency team implementation. According to the authors, for every 10% of increase in the proportion of early emergency team calls there was a 2.0 reduction per 10,000 admissions in unexpected cardiac arrests, a 2.2 reduction in overall cardiac arrests and a 0.94 reduction in unexpected deaths.

Condition HELP is a unique pediatric patient safety program that gives families an immediate voice in their child's medical care. This patient safety endeavor allows parents to call a telephone number at any time--24 hours a day, 7 days a week-if they feel their hospitalized child's immediate health is endangered. The Condition HELP call receives the same immediate attention as a life-threatening emergency, including deployment of a specialized rapid response team to the child's bedside. This article presents a 2-year analysis of pediatric patient safety outcomes following the implementation of the program. [ABSTRACT FROM AUTHOR]

Adverse events in hospitalized patients are preceded by clinical signs of decline. Thus, early recognition and intervention should improve patient outcomes. At the University of Kentucky Hospital, the impetus to start a rapid response team (RRT) was to decrease unplanned admissions to ICU, adverse events, and mortality overall. On the basis of the outcomes at our hospital, we conclude that there is benefit to having an RRT The following article outlines processes for RRT implementation and our outcomes to date. [ABSTRACT FROM AUTHOR]

Describes the implementation of rapid response team (RRT) leader in a community hospital. Goals of introducing an RRT; Criteria for calling the rapid response team; Advantages of the acute care nurse practitioner leader.

An introduction is presented in which the editor discusses the article "Activation of a Medical Emergency Team Using an Electronic Medical Recording-Based Screening System" by Jin Won Huh and colleagues published within the issue.

The authors reflect on the study of Knight and colleagues on the effectiveness of "Composite Resuscitation Team Training" in the reduction of in-house mortality among children with pediatric cardiopulmonary arrest. The authors mention that the findings of Knight and colleagues note the decreased number of cardiac arrest children among children and decreased deaths. They also cite the findings of the research that show the inefficacy of the said training.

The author reflects on implementing medical emergency team (MET) or rapid response team (RRT) for clinically unstable patients. He cites that critical care physicians must understand more about the pathophysiology of critical illness in their own hospitals. The author also asserts that physicians need to discover and dissolve the barriers that prevent staff from requesting appropriate help for their patients.

The article offers information on Early Warning Scores (EWS) that is a method of technology enhanced surveillance used to analyze patients with serious physiologic deterioration. It also mentions that along with EWS, number of medical staff and rapid response systems and effective communication strategies are also used. It discusses a study published in the issue regarding facial expression patterns, heuristics and physiologic deterioration that leads to intensive care unit (ICU) transfer.

The author reflects on the study by H. T. Stelfox and colleagues on the recurrent need of patients to be evaluated by a medical emergency team for rapid response systems (RRS). She says that the study reveals that 10% of recidivism are commonly related to respiratory cause or the lack of intensive care unit (ICU) beds. She adds that recurrence of physiologic deterioration is related to adverse outcomes such as ICU admission, high mortality, and longer ICU stay.

An introduction is presented in which the editors discuss the article "Utilization of Rapid Response Resources and Outcomes in a Comprehensive Cancer Center" by Charles A. Austin and colleagues published within the issue.

An introduction is presented in which the editor discusses the article "Using Electronic Health Record Data to Develop and Validate a Prediction Model for Adverse Outcomes in the Wards" by Matthew M. Churpek and colleagues published within the issue.

The author reflects on the study which implemented an expanded use of rapid response systems (RRS) to include patients outside critical care areas. The hospital-wide education campaign directed to hospital staff, and periodical reinforcement are presented to explain the positive results taken from the implementation of the expanded RRS. A cost-effectiveness analysis is cited to be lacking thereby making it difficult to determine if the model is generalizable to other hospital settings.

The authors reflect on the advantages and problems of a rapid response system in education of clinical and hospital personnel in order to maintain continuous care of patients. They cite factors that may contribute to the effectiveness of a rapid response system as well as the negative impact that it can bring to resident education. They state that conflicting data on the effectiveness of a rapid response system are influenced by the activities and management in teaching schools.