Can proactive rapid response team rounding improve surveillance and reduce unplanned escalations in care? A controlled before and after study

• Published in: International journal of nursing studies 2019-03, Vol.91, p.128-133
• Main Authors: Danesh, Valerie, Neff, Donna, Jones, Terry L., Aroian, Karen, Unruh, Lynn, Andrews, Diane, Guerrier, Lotricia, Venus, Sam J., Jimenez, Edgar
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Clinical outcomes; Community hospitals; Delayed; Early warning score (EWS); Emergency medical care; Escalations in care; Female; Florida; Hospital Rapid Response Team; Hospitalization; Humans; Intensive care; Intensive Care Units; Intervention; Male; Middle Aged; Nursing; Nursing Staff, Hospital; Patient assessment; Patient Transfer; Quality improvement; Quality of Health Care; Rapid response team (RRT); Redesign; Surveillance; Teams; Triage - standards; Unplanned ICU transfers; Young Adult
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2019.01.004

Unplanned escalations manifest as a breakdown of hospital care attributable to clinician error through missed or delayed identification of physiological instability, ineffective treatment, or iatrogenic harm. To examine the impact of an Early Warning Score-based proactive rapid response team model on the frequency of unplanned intra-hospital escalations in care compared with a rapid response team model based on staff nurse identification of vital sign derangements. Pre- and post Early Warning Score-guided proactive rapid response team model intervention. 237-bed community hospital in the southeastern United States. All hospitalized adults (n = 12,148) during a pre- and post-intervention period. Logistic regressions used to examine the relationship between unplanned ICU transfers and rapid response team models (rapid response team vs. Early Warning Score-guided proactive rapid response team). Unplanned ICU transfers were 1.4 times more likely to occur during the rapid response team baseline period (OR = 1.392, 95% CI [1.017–1.905]) compared with the Early Warning Score-guided proactive rapid response team intervention period. This study reports a difference in the frequency of unplanned escalations using different rapid response models, with fewer unplanned ICU transfers occurring during the use of Early Warning Score-guided proactive rapid response team model while accounting for differences in admission volumes, age, gender and comorbidities. Implementation of this model has implications for patient outcomes, hospital operations and costs.