Search

Background Aims Methods Results Conclusions Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator.To evaluate the (i) proportion of patients discharged from ICU receiving MET review and timing of reviews; (ii) characteristics of patients who received early MET review and (iii) predictors of early MET review and associations with clinical outcomes.This is a retrospective observational study of ICU discharges over 2 years in a tertiary hospital and involves descriptive and inferential statistics, including logistic regression analysis.Of 3712 patients, 312 (8.4%) had an early MET review. Patients with cardiothoracic, cardiovascular, gastrointestinal and general surgical diagnoses, higher illness severity or who received invasive ventilation had a higher risk of early MET review. On multivariable analysis, early MET review was associated with an increased risk of ICU re‐admission (odds ratio (OR) 6.76, 95% confidence interval (CI) 5.01–9.13, P < 0.001), in‐hospital mortality (OR 3.62, 95% CI 2.19–5.99, P < 0.001) and discharge to a nursing home (OR 2.49, 95% CI 1.25–4.97, P = 0.01). Length of stay was longer in patients requiring early post‐ICU MET review compared to those who did not (median 16 days vs. 10 days, P < 0.001).One in 12 patients received post‐ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk. [ABSTRACT FROM AUTHOR]

Aim: To analyse the qualitative evidence on the role of critical care nurses in rapid response teams. Design: Qualitative systematic review. Methods: This qualitative systematic review employed Bettany‐Saltikov and McSherry's guidelines and is reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist. Two pairs of blinded researchers screened the articles. The data were synthesised using a thematic analysis approach. Data Sources: A systematic literature search was conducted using the CINAHL, Embase and MEDLINE databases. Results: Seven studies were included, and three main roles were identified: (1) balancing between confidence and fear in clinical encounters, (2) facilitating collaboration and (3) managing challenging power dynamics in decision‐making. Conclusion: Critical care nurses possess extensive knowledge and skills in providing critical care to patients experiencing deterioration on general wards. They play a vital role in facilitating collaboration between team members and ward staff. Furthermore, within the rapid response team, critical care nurses assume leadership responsibilities by overseeing the comprehensive coordination of patient care and actively engaging in the decision‐making process concerning patient care. Implications for the Profession: Highlighting the central role of critical care nurses in rapid response teams as well such a team's benefits in healthcare organisations can promote applications for funding to support further quality assurance of rapid response teams and thus enhance patient safety. Impact: Health care organisations can assure the quality of rapid response team by providing economical resources and training. The education providers should facilitate and standardise curriculum for critical care nursing students to achieve necessary knowledge and skills as members in rapid response teams. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

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]

Objective: The COVID‐19 pandemic has had a substantial impact on the utilisation of hospital and emergency department (ED) services. We examined the effect of a rapid response service on hospital re‐presentations among people discharged from the ED and short‐stay wards at a tertiary referral hospital. Methods: This retrospective cohort study compared 112 patients who completed the Care in the Community program with 112 randomly selected controls. Both cases and controls were discharged from hospital between September 2020 and June 2021. Intervention patients were evaluated by a multidisciplinary team, who implemented a goal‐directed program of up to 4‐weeks duration. Logistic regression, negative binomial regression and Cox proportional hazards regression were used to evaluate outcomes at 28 days and at 6 months. Results: The median time between referral and the first home visit was 3.9 days. In adjusted analyses, the intervention reduced hospital re‐presentations at 28 days (odds ratio:.40, 95% confidence interval (CI):.17–.94) and lengthened the time to the first hospital re‐presentation (hazard ratio:.59, 95% CI:.38–.92). Although the intervention did not reduce the total number of hospital re‐presentations at 6 months (adjusted incidence rate ratio:.73, 95% CI:.49–1.08), it reduced total time spent in hospital by 303 days (582 vs. 885). Conclusions: This study is among the first to investigate the effect of a community‐based intervention on hospital re‐presentations during the COVID‐19 pandemic. It provides evidence that a sustainable 4‐week intervention is associated with reduced hospital re‐presentations and time spent in hospital. [ABSTRACT FROM AUTHOR]

Background: Navigating medical care at the end of life can be a challenging experience for patients. There are also significant resource burdens, including intensive care unit (ICU) admissions, accompanying terminal illness. For actively dying patients, developing a care plan based on patient goals and delivering care at the bedside can enhance patient well-being, avoid inappropriate transfers or interventions, and improve resource management. Methods: The Rapid Response Team (RRT) is an around the clock intensivist service that responds to all acutely decompensating patients in our hospital. Through the Appropriate Care Escalation (ACE) program, the RRT intensivist identifies amongst decompensating patients, terminally ill individuals for whom prognosis is extremely poor irrespective of available interventions. These patients receive discussions about goals of care, code status, and management options. They receive care on a dedicated stepdown unit without escalation to the ICU. If aligned with patient goals, care plans incorporate critical care interventions including ventilator and vasopressor therapy. Results: Over 5 years, RRT identified 413 terminally ill patients under the ACE program to continue end of life care on the stepdown unit. Following discussions of goals, 60.8% of patients requested DNR/DNI, 30.9% were full code, and 8.5% requested DNR/OK-TO-INTUBATE status. At discharge, 82.1% of ACE patients expired compared to 23% of all RRT consultations. Patients received 233 critical care procedures at bedside including intubations, central access catheters and bronchoscopy. Conclusion: The ACE program helped identify, in real time, actively dying, terminally ill patients, establish patient goals, and expand critical care services outside the ICU. [ABSTRACT FROM AUTHOR]

Rapid Response Teams (RRTs) are multidisciplinary, 'hospital at home' services which have developed over the last 10 years, aiming to improve recovery from illness more efficiently, prevent unnecessary hospital admission, and prevent early admission to residential care. However, little is known about the experience of professionals working in these roles. The aim of this study was to explore how working in an RRT is experienced and perceived by physiotherapists. This study used phenomenographically inspired methodology. Six participants who were working in RRTs were recruited to this study and all were working in the South of England. Data were collected via semi-structured interviews, and phenomenographic analysis was undertaken. Participants working in RRTs described a range of varied, concrete lived-through experiences in addition to a more rhetorical discussion of how they conceptualized their work. Six main categories of description were generated from the analysis; each was assigned a metaphor. These included 'the detective,' 'the guru,' 'the lone ranger,' 'the team player,' 'the bricoleur,' and 'an emotional rollercoaster'; all categories were present with varied meanings. 'An emotional rollercoaster' was present within and throughout participants' descriptions of all other categories. This study provides valuable insights into physiotherapists' experience and conceptualization of working within this discipline, which may have implications for physiotherapy practice, workforce development, new and current RR physiotherapy services, RRT health professionals, and physiotherapy education. [ABSTRACT FROM AUTHOR]

Aim: To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA). Methods: We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place. Results: Urgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement. Conclusions: A significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events.

ABSTRACTThe aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response.

Background and Aims: Vital sign monitoring needs to be timely and correct to recognize deteriorating patients early and trigger the relevant clinical response. The aim of this study is to retrospectively evaluate compliance specifically toward the regional vital sign monitoring protocol the so called early warning score protocol (EWS‐protocol) 72 h before a medical emergency team response (MET‐response) and thereby illuminate whether poor compliance translates into a worse patient outcome. Methods: It was investigated all eligible patients that underwent MET responses during the calendar year 2019. The inclusion criteria encompassed somatic patients above 18 years of age admitted to the hospital and detailed evaluations of the medical records of the included patients were conducted. Results: Four hundred and twenty‐nine MET‐responses were included in the final analysis. EWS‐protocol failure was observed for more than half the patients within all the time frames assessed. Thirty‐day mortality was significantly higher for patients subject to EWS protocol failure in the timeframes 24−16, 16−8, 8−0 h before MET response. Adjusting for admission length, age, and gender, patients subject to EWS‐protocol failure had an odds ratio (OR) of 1.9, 2.0, 2.1, 2.3 for mortality in the time frames 72−48, 24−16, 16−8, and 8−0 h before the MET‐response, respectively. The adjusted OR for ICU‐admission was 1.7, and 1.6 for patients subject to EWS‐protocol failure in the time frames 16−8 and 8−0 h before MET‐response, respectively. Conclusion: According to all the data analysis in this article, there is evidence that compliance toward the NEWS‐protocol is poor. EWS‐protocol failure is associated with a significant higher mortality and ICU‐admission rate. [ABSTRACT FROM AUTHOR]

This retrospective study assessed the effectiveness and impact of implementing a Modified Early Warning System (MEWS) and Rapid Response Team (RRT) for inpatients admitted to the general ward (GW) of a medical center. This study included all inpatients who stayed in GWs from Jan. 2017 to Feb. 2022. We divided inpatients into GWnon-MEWS and GWMEWS groups according to MEWS and RRT implementation in Aug. 2019. The primary outcome, unexpected deterioration, was defined by unplanned admission to intensive care units. We defined the detection performance and effectiveness of MEWS according to if a warning occurred within 24 h before the unplanned ICU admission. There were 129,039 inpatients included in this study, comprising 58,106 GWnon-MEWS and 71,023 GWMEWS. The numbers of inpatients who underwent an unplanned ICU admission in GWnon-MEWS and GWMEWS were 488 (.84%) and 468 (.66%), respectively, indicating that the implementation significantly reduced unexpected deterioration (p <.0001). Besides, 1,551,525 times MEWS assessments were executed for the GWMEWS. The sensitivity, specificity, positive predicted value, and negative predicted value of the MEWS were 29.9%, 98.7%, 7.09%, and 99.76%, respectively. A total of 1,568 warning signs accurately occurred within the 24 h before an unplanned ICU admission. Among them, 428 (27.3%) met the criteria for automatically calling RRT, and 1,140 signs necessitated the nursing staff to decide if they needed to call RRT. Implementing MEWS and RRT increases nursing staff's monitoring and interventions and reduces unplanned ICU admissions. [ABSTRACT FROM AUTHOR]

Chutipong Kwantong,1 Yuda Sutherasan,2 Detajin Junhasavasdikul,2 Tananchai Petnak,2 Pongdhep Theerawit3 1Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Yuda Sutherasan, Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand, Tel +6622011619, Fax +6622011629 Ext 2, Email Sutherasan_yuda@yahoo.comPurpose: The Ramathibodi Rapid Response System (RRRS), implemented in March 2017, aims to identify and respond to patients with deteriorating conditions outside the ICU. It employs the Ramathibodi early warning score and clinical signs to monitor all admitted patients, providing expert physician monitoring and early treatment for stabilization and appropriate care triage. This study assesses the RRRS’s effectiveness in reducing in-hospital mortality and CPR events outside the ICU.Patients and Methods: We conducted a retrospective observational study from March 2014 to February 2020 in a tertiary care hospital’s general wards. We included adult patients experiencing unplanned ICU admission, sudden cardiac arrest, or unexpected death. The study compared in-hospital mortality and CPR incidence outside the ICU between pre- and post-RRRS implementation groups. The associations between RRRS implementation and in-hospital mortality and the incidence of CPR outside the ICU were assessed using multiple logistic regression analyses.Results: We evaluated 17,741 admissions, with 9168 before RRRS implementation (1 March 2014 to 28 February 2017) and 8573 after RRRS implementation (1 March 2017 to 29 February 2020). The implementation of RRRS was associated with a significant reduction in in-hospital mortality, which decreased from 30.0% to 20.8% (odds ratio, 0.62; 95% confidence interval [CI], 0.57 to 0.66; P< 0.0001). Even after adjusting for age, sex, and comorbidities, the reduction in in-hospital mortality remained significant (adjusted odds ratio, 0.58; 95% CI, 0.54 to 0.63; P< 0.0001). The incidence of CPR outside the ICU also decreased from 1.8% to 1.1% (adjusted odds ratio, 0.6; 95% CI, 0.46 to 0.77; P< 0.0001). Additionally, the rate of ICU transfer increased from 85.4% to 92.1% (risk difference, 6.7; 95% CI, 7.6 to 5.8; P< 0.0001) after implementing the RRRS.Conclusion: Implementing the RRRS is associated with a reduction in in-hospital mortality and the incidence of CPR outside the ICU.Keywords: rapid response system, rapid response team, deteriorating patient, in-hospital mortality, cardiopulmonary resuscitation, intensive care unit, implementation protocol

The aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response. [ABSTRACT FROM AUTHOR]

Aim: To explore hospital managers' perceptions of the Rapid Response Team. Design: An explorative qualitative study using semi‐structured individual interviews. Methods: In September 2019, a qualitative interview study including nineteen hospital managers at three managerial levels in acute care hospitals was conducted. Interview transcripts were analysed with an inductive content analysis approach, involving researcher triangulation in data collection and analysis processes. Findings: One theme, 'A resource with untapped potential, enhancing patient safety, high‐quality nursing, and organisational cohesion' was identified and underpinned by six categories and 30 sub‐categories. Conclusion: The Rapid Response Team has an influence on the organization that goes beyond the team's original purpose. It strengthens the organization's dynamic cohesion by providing clinical support to nurses and facilitating learning, communication and collaboration across the hospital. Managers lack engagement in the team, including local key data to guide future quality improvement processes. Implications: For organizations, nursing, and patients to benefit from the team to its full potential, managerial engagement seems crucial. Impact: This study addressed possible challenges to using the Rapid Response Team optimally and found that hospital managers perceived this complex healthcare intervention as beneficial to patient safety and nursing quality, but lacked factual insight into the team's deliverances. The research impacts patient safety pointing at the need to re‐organize managerial involvement in the function and development of the Rapid Response Team and System. Reporting Method: We have adhered to the COREQ checklist when reporting this study. "No Patient or Public Contribution" [ABSTRACT FROM AUTHOR]

• Implementing rapid response teams is becoming increasingly widespread in middle-income to high-income countries. • Whether rapid response team interventions may improve patient outcomes remains inconsistent, but most studies favored rapid response teams in reducing hospital mortality and cardiac arrests. • A standardized approach to establishing and managing RRTs is needed to promote effective response measures. Despite the widespread adoption of the rapid response team (RRT) by many hospitals, questions remain regarding their effectiveness in improving several aspects of patient outcomes, such as hospital mortality, cardiopulmonary arrests, unplanned intensive care unit (ICU) admissions, and length of stay (LOS). To conduct a systematic review to understand the rapid response team's (RRT) effect on patient outcomes. A systematic search was conducted using PubMed, Cochrane, Embase, CINAHL, Web of Science, and two trial registers. The studies published up to May 6, 2022, from the inception date of the databases were included. Two researchers filtered the title, abstract and full text. The Version 2 of the Cochrane Risk of Bias tool and Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool were used separately for randomized and non-randomized controlled trials for quality appraisal. Sixty-one eligible studies were identified, four randomized controlled trials(RCTs), four non-randomized controlled trials, six interrupted time-series(ITS) design , and 47 pretest-posttest studies. A total of 52 studies reported hospital mortality, 51 studies reported cardiopulmonary arrests, 18 studies reported unplanned ICU admissions and ten studies reported LOS. This systematic review found the variation in context and the type of RRT interventions restricts direct comparisons. The evidence for improving several aspects of patient outcomes was inconsistent, with most studies demonstrating that RRT positively impacts patient outcomes. [ABSTRACT FROM AUTHOR]

Continuous vital sign monitoring (CM) may detect ward patient’s deterioration earlier than periodic monitoring. This could result in timely ICU transfers or in a transfer delay due to misperceived higher level of care on the ward. The primary objective of this study was to compare patient’s disease severity upon unplanned ICU transfer, before and after CM implementation. We included a one-year period before and after CM implementation between August 1, 2017 – July 31, 2019. Before implementation, surgical and internal medicine patients’ vital signs were periodically monitored, compared to continuous monitoring with wireless linkage to hospital systems after implementation. In both periods the same early warning score (EWS) protocol was in place. Primary outcome was disease severity scores upon ICU transfer. Secondary outcomes were ICU and hospital length of stay, incidence of mechanical ventilation and ICU mortality. In the two one-year periods 93 and 59 unplanned ICU transfer episodes were included, respectively. Median SOFA (3 (2–6) vs 4 (2–7), p =.574), APACHE II (17 (14–20) vs 16 (14–21), p =.824) and APACHE IV (59 (46–67) vs 50 (36–65), p =.187) were comparable between both periods, as were the median ICU LOS (3.0 (1.7–5.8) vs 3.1 (1.6–6.1), p.962), hospital LOS (23.6 (11.5–38.0) vs 19 (13.9–39.2), p =.880), incidence of mechanical ventilation (28 (47%) vs 22 (54%), p.490), and ICU mortality (11 (13%) vs 10 (19%), p.420). This study shows no difference in disease severity upon unplanned ICU transfer after CM implementation for patients who have deteriorated on the ward. [ABSTRACT FROM AUTHOR]

Background: In‐hospital cardiac arrest (IHCA) affects approximately 3000 patients annually in Australia. Introduction of the National Standard for Deteriorating Patients in 2011 was associated with reduced IHCA‐related intensive care unit (ICU) admissions and reduced in‐hospital mortality of such patients. Aims: To assess whether the reduction in IHCA‐related ICU admissions from hospital wards seen following the implementation of the national standard (baseline period 2013–2014) was sustained over the follow‐up period (2015–2019) in Australia. Methods: A multi‐centre retrospective cohort study to compare the characteristics and outcomes of IHCA admitted to the ICU between baseline and follow‐up periods. The primary outcome was the proportion of patients admitted to ICU from the ward following IHCA. Secondary outcomes included ICU and hospital mortality of IHCA‐related ICU admissions. Data were analysed using hierarchical multivariable logistic regression. Results: The proportion of cardiac arrest‐related admissions from the ward was lower in the follow‐up period when compared to baseline (4.1 vs 3.8%; P = 0.04). Such patients had lower illness severity and were more likely to have limitations of medical treatment at admission. However, after adjustment for severity of illness, the likelihood of being admitted to ICU following cardiac arrest on the ward increased in the follow‐up period (odds ratio (OR) 1.13 (1.05–1.22); P = 0.001). Hospital mortality was lower in the follow‐up period (50.3 vs 46.3%; P = 0.02), but after adjustment the likelihood of death did not differ between the periods (OR 1.0 (0.86–1.17); P = 0.98). Conclusion: After adjustment for the severity of illness, the likelihood of being admitted to ICU after IHCA slightly increased in the follow‐up period. [ABSTRACT FROM AUTHOR]

Abstract Background The outcomes of rapid response systems (RRS) are poorly established in older people. We examined the outcomes in older inpatients at a tertiary hospital that uses a 2-tier RRS, including the outcomes of each tier. Methods The 2-tier RRS comprised the clinical review call (CRC) (tier one) and the medical emergency team call (MET) (tier two). We compared the outcomes in four configurations of MET and CRC (MET with CRC; MET without CRC; CRC without MET; neither MET nor CRC). The primary outcome was in-hospital death, and secondary outcomes were length of stay (LOS) and new residential facility placement. Statistical analyses were carried out using Fisher’s exact tests, Kruskal-Wallis tests, and logistic regression. Results A total of 433 METs and 1,395 CRCs occurred among 3,910 consecutive admissions of mean age 84 years. The effect of a MET on death was unaffected by the occurrence of a CRC. The rates of death for MET ± CRC, and CRC without MET, were 30.5% and 18.5%, respectively. Patients having one or more MET ± CRC (adjusted odds ratio [aOR] 4.04, 95% confidence interval [CI] 2.96–5.52), and those having one or more CRC without MET (aOR 2.22, 95% CI 1.68–2.93), were more likely to die in adjusted analysis. Patients who required a MET ± CRC were more likely to be placed in a high-care residential facility (aOR 1.52, 95% CI 1.03–2.24), as were patients who required a CRC without MET (aOR 1.61, 95% CI 1.22–2.14). The LOS of patients who required a MET ± CRC, and CRC without MET, was longer than that of patients who required neither (P

Dedicated rapid response teams are created to prevent clinical decline. In a review of medical records, authors examined cardio-pulmonary arrest and activation rates over 3 years following implementation of a dedicated response team. A significant decrease in cardiopulmonary arrests and increased activations was found. [ABSTRACT FROM AUTHOR]

Background: The outcomes of rapid response systems (RRS) are poorly established in older people. We examined the outcomes in older inpatients at a tertiary hospital that uses a 2-tier RRS, including the outcomes of each tier. Methods: The 2-tier RRS comprised the clinical review call (CRC) (tier one) and the medical emergency team call (MET) (tier two). We compared the outcomes in four configurations of MET and CRC (MET with CRC; MET without CRC; CRC without MET; neither MET nor CRC). The primary outcome was in-hospital death, and secondary outcomes were length of stay (LOS) and new residential facility placement. Statistical analyses were carried out using Fisher's exact tests, Kruskal-Wallis tests, and logistic regression. Results: A total of 433 METs and 1,395 CRCs occurred among 3,910 consecutive admissions of mean age 84 years. The effect of a MET on death was unaffected by the occurrence of a CRC. The rates of death for MET ± CRC, and CRC without MET, were 30.5% and 18.5%, respectively. Patients having one or more MET ± CRC (adjusted odds ratio [aOR] 4.04, 95% confidence interval [CI] 2.96–5.52), and those having one or more CRC without MET (aOR 2.22, 95% CI 1.68–2.93), were more likely to die in adjusted analysis. Patients who required a MET ± CRC were more likely to be placed in a high-care residential facility (aOR 1.52, 95% CI 1.03–2.24), as were patients who required a CRC without MET (aOR 1.61, 95% CI 1.22–2.14). The LOS of patients who required a MET ± CRC, and CRC without MET, was longer than that of patients who required neither (P < 0.001). Conclusions: Both MET and CRC were associated with increased likelihood of death and new residential facility placement, after adjusting for factors such as age, comorbidity, and frailty. These data are important for patient prognostication, discussions on goals of care, and discharge planning. The high death rate of patients requiring a CRC (without a MET) has not been previously reported, and may suggest that CRCs among older inpatients should be expediated and attended by senior medical personnel. [ABSTRACT FROM AUTHOR]

Background: Modifications to rapid response team (RRT) activation criteria occur commonly in Australian hospitals without evidence to define their use. Aims: To evaluate the effectiveness of RRT activation criteria modifications in preventing RRT activation and differences in adverse events associated with treatment delays caused by modifications. Methods: A prospective chart audit of hospital patients with RRT activation criteria modifications admitted during a 12‐month period in a large regional hospital in Toowoomba, Australia. The incidence of RRT activation criteria modifications, RRT activations and rates of adverse events following criteria modifications were investigated. Adverse events were defined as a delayed treatment on the ward, unplanned intensive care unit admission, cardiac arrest and unexpected death. Differences in patient outcomes among medical and surgical patients were also investigated. Results: A total of 271 patients out of 4009 admitted patients had modifications to their RRT activation criteria. There was no difference in rates of RRT activation in patients with modified criteria compared with patients with unmodified criteria (P = 0.37). In patients with RRT activation criteria modifications, rates of adverse events were higher in patients who met their modified RRT criteria (93.3%) compared with those who did not meet modified RRT criteria (3.8%; P < 0.001). Additionally, in patients with modifications, rates of adverse events were higher in medical patients (27.6%; n = 50) compared with surgical patients (15.6%; n = 14; P = 0.03). Conclusions: The results strongly suggest that RRT criteria modification is associated with no difference in rates of RRT activation and with detrimental impacts on patient safety, particularly in medical patients. [ABSTRACT FROM AUTHOR]

Introduction: Hypotension is an acute complication following Emergency Endotracheal Intubation (ETI) in populations who called the Rapid Response Team (RRT). Thus, a fast and simple tool is needed to identify the risk of Post-emergency Intubation Hypotension (PIH). Shock Index (SI) pre-intubation is one of the potential factors to predict PIH. Objective: To measure the association between shock index with post-emergency intubation hypotension after calling for the RRT. Materials and Methods: This research is a cohort retrospective study that analyzed 171 patients aged ≥18 years who have called RRT and underwent an emergency ETI. The cut-off point for SI was determined using the ROC curve to predict PIH. The modification effect was evaluated using stratification analysis. Data were analyzed using cox regression to determine the likelihood of SI in the cause of hypotension. Result: A total of 92 patients (53.8%) underwent post-emergency intubation hypotension. The SI cut-off point of 0.9 had a sensitivity of 82.6% and a specificity of 67.1% for predicting PIH (Area Under Curve (AUC) 0.81; 95% CI 0.754–0.882, p

Abstract Background Medical emergency teams (METs) have been implemented to reduce hospital mortality by the early recognition and treatment of potentially life-threatening conditions. The objective of this study was to establish a clinically useful association between clinical variables and mortality risk, among patients assessed by the MET, and further to design an easy-to-use risk score for the prediction of death within 30 days. Methods Observational retrospective register study in a tertiary university hospital in Sweden, comprising 2,601 patients, assessed by the MET from 2010 to 2015. Patient registry data at the time of MET assessment was analysed from an epidemiological perspective, using univariable and multivariable analyses with death within 30 days as the outcome variable. Predictors of outcome were defined from age, gender, type of ward for admittance, previous medical history, acute medical condition, vital parameters and laboratory biomarkers. Identified factors independently associated with mortality were then used to develop a prognostic risk score for mortality. Results The overall 30-day mortality was high (29.0%). We identified thirteen factors independently associated with 30-day mortality concerning; age, type of ward for admittance, vital parameters, laboratory biomarkers, previous medical history and acute medical condition. A MET risk score for mortality based on the impact of these individual thirteen factors in the model yielded a median (range) AUC of 0.780 (0.774–0.785) with good calibration. When corrected for optimism by internal validation, the score yielded a median (range) AUC of 0.768 (0.762–0.773). Conclusions Among clinical variables available at the time of MET assessment, thirteen factors were found to be independently associated with 30-day mortality. By applying a simple risk scoring system based on these individual factors, patients at higher risk of dying within 30 days after the MET assessment may be identified and treated earlier in the process.

Objective:Rapid response systems (RRSs), which aim to prevent cardiac arrests and unexpected deaths, have been implemented across hospitals worldwide. Most studies on RRS shave evaluated the effects of its implementation on in-hospital mortality. In this study, we evaluated the predictive factors of in-hospital mortality for patients who were subjects of RRS activation in a newly established major hospital in Turkey.Materials and Methods:Data on RRS activations were reviewed from paper charts and electronic medical records between March 2019 and February 2020. The demographic characteristics of patients, time of and reasons for RRS activation, initial cardiac rhythm, heart rate, mean arterial pressure, pulse oximetry-measured blood oxygen saturation (SpO2), time of arrival of the rapid response team, red cell distribution width, platelet distribution width obtained from the first blood gas analysis and haemogram test results as well as glucose, sodium, potassium, pH, lactate, neutrophils and lymphocyte levelswere recorded. Univariate and multivariate logistic regression analyses were conducted to determine the independent predictors of in-hospital mortality.Results:A total of 531 patients were included in the analysis. Of these, 189 (35.6%) died during hospital admission. Compared with survivors, non-survivors were older (median age, 64 vs. 52 years) and more likely to be male (65.6% vs. 34.4%); be admitted for cardiovascular, pulmonary and oncologic diseases and trigger RRS at nightand weekends than during the day. Activation of RRS by respiratory and haemodynamic triggers as well as during nighttime and weekend hours oncologic reasons for hospital admission, low SpO2 levels, high neutrophil-to-lymphocyte ratio (NLR), potassium levels and lactate levels were predictive of in-hospital mortality.Conclusion:This study found some weaknesses in the current RRS of the hospital. Hospital staffs working overnight and on weekends should be trained and empowered. SpO2, potassium and lactate levels as well as NLR are predictors of in-hospital mortality and can guide triage decision making, which is usually a challenging and stressful task.

Mayo Clinic's virtual hybrid hospital-at-home program, Advanced Care at Home (ACH) monitors acute and post-acute patients for signs of deterioration and institutes a rapid response (RR) system if detected. This study aimed to describe Mayo Clinic's ACH RR team and its effect on emergency department (ED) use and readmission rates. This was a retrospective review of all post-inpatient (restorative phase) ACH patients admitted from July 6, 2020 through June 30, 2021. If the restorative patient had a clinical decompensation, an RR was activated. All RR activations were analyzed for patient demographic characteristics, admitting and escalation diagnosis, time spent by virtual team on the RR, and whether the RR resulted in transport to the ED or hospital readmission. Three hundred and twenty patients were admitted to ACH during the study interval; 230 received restorative care. Seventy-two patients (31.3%) had events that triggered an RR. Fifty (69.4%) of the RR events were related to the admission diagnosis (p < 0.001; 95% CI 0.59–0.80). Twelve patients (16.7%) required transport to an ED for further treatment and were readmitted and 60 patients (83.3%) were able to be treated successfully in the home by the RR team (p < 0.001; 95% CI 0.08–0.25). The use of an ACH RR team was effective at limiting both escalations back to an ED and hospital readmissions, as 83% of deteriorating patients were successfully stabilized and managed in their homes. Implementing a hospital-at-home RR team can reduce the need for ED use by providing critical resources and carrying out required interventions to stabilize the patient's condition. [ABSTRACT FROM AUTHOR]

Rapid reponse teams emerged 27 years ago to identify deteriorating patients and reduce preventable harm. There are concerns that such teams have deskilled hospital staff. However, over the past 20 years, there have been marked changes in hospital care and workplace requirements for hospital staff. In this article, we contend that hospital staff have been reskilled rather than deskilled. [ABSTRACT FROM AUTHOR]

Background: Rapid Response Teams (RRTs) help in the early recognition of deteriorating patients in hospital wards, and provide the needed management at the bedside by a qualified team. Aim of the Work: To describe the characteristics of the RRT calls in a tertiary hospital in Egypt. Patients and Methods: A prospective cohort study for a one-year duration from January 2021 till December, 2021was conducted, during this period a total of 2338 patients were reviewed, and 34 RRT calls were recorded. Results: Our results showed that 10 calls (63%) of Rapid Response Team calls were in the daytime, and Nurses were the main activators with 27 activations (90%). Modified Early Warning scoring system (MEWS) and Pediatric Early Warning Score (PEWS) used were the main cause of RRT activation with a total of (66.7%), the majority of cases didn't refer to the Intensive Care Unit (ICU), 19 patients stay in the ward (76%) and 22 cases (100%) were recovered. Conclusion: More than half of RRT calls were in the daytime, and nurses were the main activators. Most rapid response team activations involve relatively few interventions, patient-activated RRT should consider as a patient right in the future, and further studies showed be conducted to evaluate the best effective methods for applying RRT among different health care facilities. [ABSTRACT FROM AUTHOR]

Emergency cesarean section is one of the most critical methods in the treatment of high-risk emergency obstetric cases. The aim of this study was to explore the clinical effect of constructing a Rapid Response Team (RRT) in emergency cesarean section. This is a pre- and post-implementation study. The patients who underwent emergency cesarean section were retrospectively analyzed and divided into an experimental group and a control group. There were 52 patients (June–December 2020) in the control group who underwent routine emergency cesarean section without an RRT, and 51 patients (January–June 2021) in the experimental group who underwent emergency cesarean section with an RRT. The operation time indexes (DOI, decision-to-operating room interval; O-I, operating room-to-incision interval; DII, decision-to-incision interval; I-D, incision-to-delivery interval; DDI, decision-to-delivery interval), DDI pass rate, neonatal Apgar score and maternal complications in the two groups were compared. Moreover, the management time trends (DOI, DII, and DDI) in the experimental group were analyzed. The DDI, DII, DOI, and O-I of the experimental group were shorter than those of the control group, and the differences were significant (p < 0.05). The DDI pass rate in the experimental group was higher than that in the control group, and the difference was significant (p < 0.01). The 1-min Apgar score of the experimental group was higher than that of the control group (p < 0.05). The key intervals of emergency cesarean section in the experimental group leveled off after approximately 3 to 4 months. In the face of emergency situations, the implementation of an emergency cesarean section RRT can improve delivery intervals for emergency cesarean and would be conducive to maternal and infant safety. [ABSTRACT FROM AUTHOR]

Background: Medical emergency teams (METs) have been implemented to reduce hospital mortality by the early recognition and treatment of potentially life-threatening conditions. The objective of this study was to establish a clinically useful association between clinical variables and mortality risk, among patients assessed by the MET, and further to design an easy-to-use risk score for the prediction of death within 30 days. Methods: Observational retrospective register study in a tertiary university hospital in Sweden, comprising 2,601 patients, assessed by the MET from 2010 to 2015. Patient registry data at the time of MET assessment was analysed from an epidemiological perspective, using univariable and multivariable analyses with death within 30 days as the outcome variable. Predictors of outcome were defined from age, gender, type of ward for admittance, previous medical history, acute medical condition, vital parameters and laboratory biomarkers. Identified factors independently associated with mortality were then used to develop a prognostic risk score for mortality. Results: The overall 30-day mortality was high (29.0%). We identified thirteen factors independently associated with 30-day mortality concerning; age, type of ward for admittance, vital parameters, laboratory biomarkers, previous medical history and acute medical condition. A MET risk score for mortality based on the impact of these individual thirteen factors in the model yielded a median (range) AUC of 0.780 (0.774–0.785) with good calibration. When corrected for optimism by internal validation, the score yielded a median (range) AUC of 0.768 (0.762–0.773). Conclusions: Among clinical variables available at the time of MET assessment, thirteen factors were found to be independently associated with 30-day mortality. By applying a simple risk scoring system based on these individual factors, patients at higher risk of dying within 30 days after the MET assessment may be identified and treated earlier in the process. [ABSTRACT FROM AUTHOR]

Background: Approximately one-third of rapid response teams (RRT) involve end-oflife care (EOLC) issues. Intensive care unit (ICU) registrar experience in such calls is underinvestigated. Aims: To evaluate the proportion of RRT calls triaged as relating to EOLC issues, issues around communication regarding prognostication, registrar self-reported moral distress and associations between RRT EOLC classification and patient outcomes. Methods: Prospective observational study of RRT calls in a tertiary referrals hospital between December 2016 and January 2017 using a standardised case report form and data from an electronic RRT database. Results: There were 401 RRT calls in the study period, and data were available for 270 (67%) calls, of which 72%, 10% and 18% were triaged as ‘obviously not EOLC call’, ‘obvious EOLC call’ and ‘uncertain EOLC call’ respectively. Most discussions regarding prognostication occurred between registrars, and more than half (55%) were with a covering doctor. Consensus on prognostication was achieved in 93% cases. Registrars reported distress in 19% of calls that obviously related to EOLC and 22% of calls that were uncertain, compared with <1% of calls that were obviously not relating to EOLC. Inhospital mortality was 6%, 67% and 39% for obviously not EOLC, obvious EOLC and uncertain EOLC calls respectively. Conclusions: EOLC issues occur commonly in RRT calls and are often associated with moral distress to ICU registrars. Although consensus on prognostication is usually achieved, conversations often involve covering doctors. These issues impact on the ICU registrar experience of RRT calls and require further exploration. [ABSTRACT FROM AUTHOR]

Prior studies analyzing patient experience with noninvasive ventilation (NIV) found the most impactful interaction that patients remembered was with nurses, however a survey of nurses regarding the management of patients treated with NIV has shown that most nurses felt unprepared to care for these sick patients. Our qualitative descriptive study explored the current nursing experience using NIV as a treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Nine (n = 9) subject matter expert nurses practicing in a variety of clinical settings participated in semi‐structured interviews. The COnsolidated criteria for REporting Qualitative research checklist was followed for interview development. Interview transcripts were subsequently analyzed using deductive thematic analysis. Themes identified from the interviews pertained to patient assessment, novice nurses' need for clinical support, team communication, and nursing education. Improving interprofessional team communication and collaboration skills, and implementing guidelines for NIV utilization were specified as essential components of NIV education for nurses. Even though the nursing role in the care of AECOPD NIV patient could be institution dependent, the themes presented in our study are useful in identifying opportunities for NIV nursing education and areas for further research. Patient or Public Contribution: Nurses served as interviewees for this study. [ABSTRACT FROM AUTHOR]

While timely activation and collaborative teamwork of Rapid Response Teams (RRTs) are crucial to promote a culture of safety and reduce preventable adverse events, these do not always occur. Understanding nurses' perceptions of and experiences with RRTs is important to inform education and policy that improve nurse performance, RRT effectiveness, and patient outcomes. The aim of this study was to explore nurse perceptions of detecting patient deterioration, deciding to initiate RRTs, and experience during and at conclusion of RRTs. A qualitative descriptive study using semi-structured focus group interviews was conducted with 24 nurses in a Chicago area hospital. Interviews were audio-recorded, transcribed verbatim, and coded independently by investigators. Thematic analysis identified and organized patterns of meaning across participants. Several strategies supported trustworthiness. Data revealed five main themes: identification of deterioration, deciding to escalate care, responsiveness of peers/team, communication during rapid responses, and perception of effectiveness. Findings provide insight into developing a work environment supportive of nurse performance and interprofessional collaboration to improve RRT effectiveness. Nurses described challenges in identification of subtle changes in patient deterioration. Delayed RRT activation was primarily related to negative attitudes of responders and stigma. RRT interventions were often considered a temporary fix leading to subsequent RRTs, especially when patients needing a higher level of care were not transferred. Implications include the need for ongoing RRT monitoring and education on several areas such as patient hand-off, RRT activation, nurse empowerment, interprofessional communication, role delineation, and code status discussions. • Timely activation and teamwork, crucial to RRT effectiveness, do not always occur. • Focus group interviews explored nurse experiences with RRTs. • Using RRTs as band-aid approach to address patient deterioration was frustrating. • Nurses can struggle to "paint a clinical picture" of deterioration. • Bedside report played a critical role in identifying subtle patient changes. [ABSTRACT FROM AUTHOR]

Abstract Background The utilization of a rapid response team (RRT) has influenced the clinical outcomes of patients in the general ward. However, the characteristics of RRT-screened patients who are transferred to the intensive care unit (ICU) are unknown. Therefore, the present study aimed to evaluate these factors. Methods We conducted a retrospective study using patient data from a tertiary medical center in Republic of Korea between January 2016 and December 2017. Multivariate logistic regression analyses were performed to assess the factors associated with the risk of in-hospital mortality. Results A total of 1,096 patients were included: 389 patients were transferred to the ICU, and 707 patients stayed in the ward. Patients in the ICU group were more likely to be admitted for medical reasons, hepatobiliary disease, and high heart rate. More interventions were performed, hospital stays were longer, and the 28-day and in-hospital mortality rates were higher in the ICU group than in the ward group. Multivariate logistic regression analyses showed that risk factors affecting ICU admission were higher Sequential Organ Failure Assessment (SOFA) score, National Early Warning Score (NEWS), platelet count, and lactate level. ICU transfer was not associated with in-hospital mortality. Conclusions Among RRT-screened patients, those with higher SOFA score, NEWS, and lactate level were more likely to be transferred to the ICU. Therefore, these patients should be closely monitored and considered for ICU transfer.

Abstract Background Rapid response systems (RRSs) are essential components of patient safety systems; however, limited evidence exists regarding their effectiveness and optimal structures. We aimed to assess the activation patterns and outcomes of RRS implementation with/without a real-time automatic alerting system (AAS) based on electronic medical records (EMRs). Methods We retrospectively analyzed clinical data of patients for whom the RRS was activated in the surgical wards of a tertiary university hospital. We compared the code rate, in-hospital mortality, unplanned intensive care unit (ICU) admission, and other clinical outcomes before and after applying RRS and AAS as follows: pre-RRS (January 2013–July 2015), RRS without AAS (August 2015–November 2016), and RRS with AAS (December 2016–December 2017). Results In-hospital mortality per 1000 admissions decreased from 15.1 to 12.9 after RRS implementation (p

The article introduces the Patient Vigilance System (PVS) to reduce rapid response system (RRS) calls and improve patient care planning, demonstrating that the PVS significantly increased the proportion of patients with clinical plans after RRS calls.

In view of the shortage of medical staff, the quality and continuity of care may be improved by employing advanced practice providers (APPs). This study aims to assess the quality of these APPs in critical care. In a large teaching hospital, rapid response team (RRT) interventions led by APPs were assessed by independent observers and intensivists and compared to those led by medical residents MRs. In addition to mortality, the MAELOR tool (assessment of RRT intervention), time from RRT call until arrival at the scene and time until completion of clinical investigations were assessed. Process outcomes were assessed with the crisis management skills checklist, the Ottawa global rating scale and the Mayo high-performance teamwork scale. The intensivists assessed performance with the handoff CEX recipient scale. Mortality, MAELOR tool, time until arrival and clinical investigation in both groups were the same. Process outcomes and performance observer scores were also equal. The CEX recipient scores, however, showed differences between MRs and APPs that increased with experience. Experienced APPs had significantly better situational awareness, better organization, better evaluations and better judgment than MRs with equal experience (p < 0.05). This study shows that APPs perform well in leading an RRT and may provide added quality over a resident. RRTs should seriously consider the deployment of APPs instead of junior clinicians. [ABSTRACT FROM AUTHOR]

Objective: Rapid response systems (RRSs), which aim to prevent cardiac arrests and unexpected deaths, have been implemented across hospitals worldwide. Most studies on RRS shave evaluated the effects of its implementation on in-hospital mortality. In this study, we evaluated the predictive factors of in-hospital mortality for patients who were subjects of RRS activation in a newly established major hospital in Turkey. Materials and Methods: Data on RRS activations were reviewed from paper charts and electronic medical records between March 2019 and February 2020. The demographic characteristics of patients, time of and reasons for RRS activation, initial cardiac rhythm, heart rate, mean arterial pressure, pulse oximetry-measured blood oxygen saturation (SpO2), time of arrival of the rapid response team, red cell distribution width, platelet distribution width obtained from the first blood gas analysis and haemogram test results as well as glucose, sodium, potassium, pH, lactate, neutrophils and lymphocyte levels were recorded. Univariate and multivariate logistic regression analyses were conducted to determine the independent predictors of in-hospital mortality. Results: A total of 531 patients were included in the analysis. Of these, 189 (35.6%) died during hospital admission. Compared with survivors, non-survivors were older (median age, 64 vs. 52 years) and more likely to be male (65.6% vs. 34.4%); be admitted for cardiovascular, pulmonary and oncologic diseases and trigger RRS at night and weekends than during the day. Activation of RRS by respiratory and haemodynamic triggers as well as during nighttime and weekend hours oncologic reasons for hospital admission, low SpO2 levels, high neutrophil-to-lymphocyte ratio (NLR), potassium levels and lactate levels were predictive of in-hospital mortality. Conclusion: This study found some weaknesses in the current RRS of the hospital. Hospital staffs working overnight and on weekends should be trained and empowered. SpO2, potassium and lactate levels as well as NLR are predictors of in-hospital mortality and can guide triage decision making, which is usually a challenging and stressful task. [ABSTRACT FROM AUTHOR]

BACKGROUND: Noninvasive respiratory support (NRS) has been used to treat acute respiratory failure outside the ICU, but existing data have left many knowledge gaps for managing NRS in general wards. The primary objective of this study was to describe indications, duration of treatment, and outcomes of subjects treated with NRS outside the ICU. The secondary objective was to compare outcomes based on age < 80 or ≥ 80 y. METHODS: This retrospective observational study was conducted at Maggiore della Carita University Hospital in Novara, Italy, and included all patients treated with noninvasive ventilation (NIV) or CPAP outside the ICU from November 2017 to October 2018, with 1 year of follow-up. RESULTS: Of the 570 treatments performed, 383 subjects were analyzed, 136 NIV and 247 CPAP. Subjects' median (interquartile range [IQR]) age was 79 (72-85) y, and the main diagnoses of respiratory failure were cardiogenic pulmonary edema in 128 subjects (33%), pneumonia in 99 (26%), and COPD exacerbation in 52 (14%), with a median (IQR) treatment duration of 38 (16-74) h. Rapid response team visits lasted a median (IQR) 3 (2-6) d. Interface-related pressure lesions occurred in 13% of the subjects, in no case leading to definitive treatment discontinuation. Compared with the subjects ≥ 80 y old, the younger subjects had a median (IQR) longer hospitalization (16 [10-24] d vs 13 [9-20] d; P = .003) but slightly decreased in-hospital mortality (21% vs 30%; P = .061) and a decreased post-discharged 1-year mortality in hospital survivors (25% vs 41%; P = .002), differences observed only in the subjects treated with NIV. CONCLUSIONS: In a real-life setting outside the ICU, NIV and CPAP managed by a rapid response team with a daily visit in collaboration with ward staff highly experienced in NRS allowed us to treat the subjects without major complications. Post-discharge 1-year mortality was higher in the subjects ≥ 80 y old treated with NIV for acute hypercapnic respiratory failure. [ABSTRACT FROM AUTHOR]

Aim: To determine the frequency with which the National Early Warning Score-2 (NEWS-2) fails to detect physiological deterioration preceding in-hospital cardiac arrest (IHCA)., Methods: We conducted a retrospective observational study of all adult patients (age ≥ 18) who had suffered an IHCA between 1st July 2019 and 31st December 2021 in two large acute hospitals located in an urban centre (Nottingham, UK). Clinical observations and case notes were examined for the period leading up to IHCA events to determine if there was evidence of physiological deterioration which warranted an urgent patient assessment, whether NEWS-2 was triggered, and whether an urgent assessment actually took place., Results: Urgent assessment was indicated in the lead-up to 126/374 (33.7 %) IHCA cases, and NEWS-2 failed to trigger in 20 of these cases (15.9 %). An urgent assessment took place in 89/106 (84.0 %) cases where NEWS-2 was triggered, and 13/20 (65.0 %) cases where NEWS-2 was not triggered, with the difference in proportions being statistically significant (p = 0.048). Half of cases in which NEWS-2 missed a physiological deterioration were related to a new or rising oxygen requirement., Conclusions: A significant proportion of IHCA events are preceded by clinically important abnormalities in vital signs which are not detected by NEWS-2. This may be a causative factor in some failure-to-rescue events., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Data Access Statement Study data are not currently available for sharing due to ethical and institutional restrictions. Requests for data sharing should be directed to the corresponding author., (© 2024 The Author(s).)

This study describes the apparent discontinuation of cholera transmission in Haiti since February 2019. Because vulnerabilities persist and vaccination remains limited, our findings suggest that case-area targeted interventions conducted by rapid response teams played a key role. We question the presence of environmental reservoirs in Haiti and discuss progress toward elimination.

Background: Delayed transfer to the intensive care unit (ICU) contributes to increased mortality. Clinical tools, developed to shorten this delay, are especially useful in hospitals where the ideal healthcare provider-to-patient ratio is not met. This study aimed to validate and compare the accuracy of the well-accepted modified early warning score (MEWS) and the newer cardiac arrest risk triage (CART) score in the Philippine setting. Patients and methods: This case-control study involved 82 adult patients admitted to the Philippine Heart Center. Patients who had cardiopulmonary (CP) arrest at the wards and those transferred to the ICU were included. Vital signs and alert-verbal-pain-unresponsive (AVPU) scales were recorded from recruitment until 48 hours prior to CP arrest or ICU transfer. The MEWS and CART scores were computed at specific time points and compared using measures of validity. Results: The highest accuracy was obtained by the CART score with a cut-off of ≥12 at 8 hours prior to CP arrest or ICU transfer, with a specificity of 80.43% and sensitivity of 66.67%. At this time point, the MEWS with a cut-off of ≥3 had a specificity of 78.26% but a lower sensitivity of 58.33%. The area under the curve (AUC) analysis revealed that these differences were not statistically significant. Conclusion: We recommend an MEWS threshold of 3 and a CART score threshold of 12 to help identify patients at risk for clinical deterioration. The CART score had comparable accuracy to the MEWS, but the latter's computation may be easier. [ABSTRACT FROM AUTHOR]

Background: In contrast to prehospital care there is a lack of specifications for the organization and equipment of medical emergency teams for in-hospital emergency care. Objective: Evaluation of the organization, team composition, training, equipment and tasks of medical emergency teams in the Federal Republic of Germany. Material and methods: Evaluation of a web-based survey of all hospitals participating in the German Resuscitation Register between February and March2020. The participants were asked about team composition; emergency equipment; type, content and scope of special training or further training as well as other additional tasks in the everyday clinical routine when participating in the medical emergency team. Hospitals with ≤ or >600 beds were compared. Results: A total of 21 (>600 beds: 10, 48%; ≤600 beds: 11, 52%) hospitals participated in the survey. Team composition requirements were present at 76% (n = 16; ≤600 beds: 8, 72% vs. >600 beds: 8, 80%), training requirements for medical emergency teams at 38% (n = 16; ≤600 beds: 4, 36% vs. >600 beds: 4, 40%) of hospitals, with a focus on cardiac life support (n = 6, 28%; ≤600 beds: 3, 27% vs. >600 beds: 3, 30%) and airway management (n = 4, 19%; ≤600 beds: 3, 27% vs. >600 beds: 1, 10%). A 12-lead electrocardiogram (n = 7, 33%; ≤600 beds: 1, 9% vs. >600 beds: 6, 60%; p = 0.02), video laryngoscope (n = 7, 33%; ≤600 beds: 2, 18% vs. >600 beds: 5, 50%), ventilator without (n = 7, 33%; ≤600 beds: 2, 18% vs. >600 beds: 5, 50%) or with the possibility of non-invasive ventilation was part of the standard equipment in n = 4, 19% (≤600 beds: 1, 9% vs. >600 beds: 3, 30%). A total of 85% (n = 18; ≤600 beds: 10, 100% vs. >600 beds 8, 72%), had additional tasks in the daily clinical routine. While clinics with >600 beds staffed medical emergency teams 100% of the time from the intensive care units, in clinics ≤600 beds medical emergency teams were deployed significantly more often in the emergency department (n = 5, 45%) and in the normal wards (n = 5, 45%, p = 0.03). Conclusion: Training and equipment of medical emergency teams in the Federal Republic of Germany is heterogeneous. They should at least meet the standards commonly used in prehospital emergency medicine and include the availability of a portable 12-lead electrocardiogram, a ventilator with the possibility of noninvasive ventilation and a video laryngoscope. Regardless of the size of the hospital, continuous availability of all members of the medical emergency teams should be ensured. [ABSTRACT FROM AUTHOR]

Background: The increased complexity of the nursing care needs of patients and acuity in general wards present nursing care challenges for nurses. Self-led nurses are attentive, taking responsibility for activating the rapid response service when a patient is starting to deteriorate. Objectives: The purpose of this article is to describe nurses’ experiences practising mindfulness during self-leadership in delivering a rapid response system (RRS) in a private hospital in Gauteng. Method: A qualitative, exploratory, descriptive and contextual design was followed. Homogenous purposive sampling was used and a total of eight focus groups were conducted. Focus groups durations were between 45 min and 60 min. The data analysis was carried out through open coding on Atlas.ti using the noticing things, collecting things and thinking about things (NCT) approach. An independent coder met with the researcher during a consensus meeting and finalised the analysis. Results: The findings indicated an underlying theme of nurses being mindful in their self-leadership through the development of self-motivation and self-direction in the RRS. Three categories with six subcategories emerged from the data analysis, namely self-motivation in an RRS by the team, self-direction through role-modelling to peers and training. Conclusion: Nurses practised mindfulness during self-leadership, utilising behavioural and natural reward approaches and constructive thought patterns. These findings could assist management with developing training programmes for nurses.

Abstract Background Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients. Materials and methods We conducted a scoping review according to PRISMA-ScR guidelines. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Studies of short stay units and observation wards; deterioration during the triage process; system or score development or validation; and systems requiring pathology test results were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings. Results After removal of duplicates, there were 2696 publications. Of these 33 studies representing 109,066 patients were included: all were observational studies. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED; ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating. Conclusion There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.

In March 2021, Lao People's Democratic Republic (Laos) reported an avian influenza A(H5N6) virus infection in a 5‐year‐old child identified through sentinel surveillance. This was the first human A(H5N6) infection reported outside of China. A multidisciplinary investigation undertook contact tracing and enhanced human and animal surveillance in surrounding villages and live bird markets. Seven Muscovy ducks tested positive for highly pathogenic avian influenza A(H5N6) viruses. Sequenced viruses belonged to clade 2.3.4.4h and were closely related to viruses detected in poultry in Vietnam and to previous viruses detected in Laos. Surveillance and coordinated outbreak response remain essential to global health security. [ABSTRACT FROM AUTHOR]

Background: Information about the epidemiology of older Internal Medicine patients receiving medical emergency team (MET) calls is limited. We assessed the prevalence, characteristics, risk factors, and outcomes of this vulnerable group. Methods: Internal Medicine patients aged >75 years who were admitted via the Emergency Department to a tertiary hospital between January 2015 to December 2018 and who activated a MET call were compared to patients without MET call activation during the same time period. Outcome measures included management post‐MET call, Intensive Care Unit (ICU) admission rates, discharge disposition, length of hospital stays (LOS), and in‐patient mortality. Results: There were 10,803 Internal Medical admissions involving 10,423 patients; median age 85 (IQR 81–89) years. Of these, 995 (10%) patients received at least one MET call. MET call patients had greater physiological instability in the Emergency Department and higher median Charlson comorbidity index values (2, IQR 1–3 vs. 1, IQR 0–2; p <.0001) than non‐MET call patients. Overall, 10% of MET call patients were admitted to ICU. MET patients had a longer median length of stay (9 [IQR 5–14] vs. 4 days [IQR 2–7]; p <.001) and higher in‐hospital mortality (29% vs. 7%; p <.001). However, mortality of MET call patients without treatment limitations was 48/357 (13%). Conclusion: One in ten Internal Medicine patients aged >75 years and admitted via ED had a MET call. Physiological instability in ED and comorbidities were key risk factors. Mortality in MET patients approached 30%. These data can help predict at‐risk patients for improving goals of care and pre‐MET interventions. [ABSTRACT FROM AUTHOR]

Abstract Background Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes. Methods A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group). Results We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group (p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 [10–25] min vs. 34 [15–40] min, p