In-hospital emergency: how to identify the patient in crisis

Marcello Difonzo, Antonio Bisceglie

DOI: https://doi.org/10.7175/cmi.v9i3.1185

Abstract

In-hospital emergency is a system designed to ensure an adequate response, in rapidity and appropriateness, to cardiac arrests and other medical emergencies, in general wards and in not-medical areas of the hospital. Early treatment of unstable patients, hospitalized in non-intensive care unit, reduces the incidence of serious adverse events such as unexpected cardiac arrest, unplanned intensive care admissions, and unexpected death.

The Rapid Response System (RRS) describes the entire process of in-hospital emergency planning. The afferent limb of the RRS is the way, managed by the ward staff, doctors and nurses, to identify the patient in crisis, at risk of physiological deterioration, and enable an appropriate response. The afferent limb includes the monitoring, the recognition of patient’s deterioration and the activation of the emergency team.

The aim of this study is to describe the dynamics of the afferent limb, focusing on the evidence about early detection of the clinical deterioration in a general ward.

Keywords

Patient in crisis; Deteriorating ward patient; Afferent limb; Rapid response systems

Full Text

HTML PDF

References

  • Rosengart MR, Pinsky MR. Origins of the critically ill: the impetus for critical care medicine. In: Scales DC, Rubenfeld GD (eds.). The organization of critical care. An evidence-based approach to improving quality. Respiratory medicine 18. Springer Science Business Media New York, 2014. Disponibile all’indirizzo: http://link.springer.com/chapter/10.1007/978-1-4939-0811-0_2 (ultimo accesso luglio 2015)
  • Safar P. Critical care medicine-quo vadis? Crit Care Med 1974; 2: 1-5; http://dx.doi.org/10.1097/00003246-197401000-00001
  • Hillman K. Critical care without walls. Curr Opin Crit Care 2002; 8: 594-9; http://dx.doi.org/10.1097/00075198-200212000-00019
  • DeVita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006; 34: 2463-78; http://dx.doi.org/10.1097/01.CCM.0000235743.38172.6E
  • Schein RM, Hazday N, Pena M, et al. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 1990; 98: 1388-92; http://dx.doi.org/10.1378/chest.98.6.1388
  • Franklin C, Mathew J. Developing strategies to prevent in hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med 1994; 22: 244-7; http://dx.doi.org/10.1097/00003246-199402000-00014
  • McQuillan P, Pilkington S, Allan A, et al. Confidential inquiry into quality of care before admission to intensive care. Br J Med 1998; 316: 1853-8; http://dx.doi.org/10.1136/bmj.316.7148.1853
  • Hesselfeldt R, Fuhrmann L, Lippert A, et al. Are patients fulfilling MET criteria recognized? Scand J Trauma Resusc Emerg Med 2009; 17 (Suppl 3): O19; http://dx.doi.org/10.1186/1757-7241-17-S3-O19
  • Jones DA, DeVita MA, Bellomo R. Rapid-Response Teams. N Engl J Med 2011; 365: 139-46; http://dx.doi.org/10.1056/NEJMra0910926
  • Goldhill DR, McNarry A. Intensive care outreach services. Curr Anaesth Crit Care 2002; 13: 356-61; http://dx.doi.org/10.1054/cacc.2003.0433
  • Winters BD, DeVita M. Rapid Response Systems history and terminology. In: DeVita MA, Hillman K, Bellomo R (eds.). Textbook of Rapid Response Systems: concept and implementation. Springer Science Business Media, LLC 2011; http://dx.doi.org/10.1007/978-0-387-92853-1_1
  • Massey D, Aitken LM, Chaboyerb W. A literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient. J Clin Nurs 2010; 19: 3260-73; http://dx.doi.org/10.1111/j.1365-2702.2010.03394.x
  • Russo SG, Eich C, Roessler M. Medical emergency teams: current situation and perspectives of preventive in-hospital intensive care medicine. Anaesthesist 2008; 57: 70-80; http://dx.doi.org/10.1007/s00101-007-1271-0
  • Bell MB, Konrad D, Granath F, et al. Prevalence and sensitivity of MET-criteria in a Scandinavian University Hospital. Resuscitation 2006; 70: 66-73; http://dx.doi.org/10.1016/j.resuscitation.2005.11.011
  • Sandroni C, D’Arrigo S, Antonelli M. Rapid response systems: are they really effective? Critical Care 2015; 19: 104; http://dx.doi.org/10.1186/s13054-015-0807-y
  • DeVita MA, Smith GB, Adam SK, et al. “Identifying the hospitalised patient in crisis”-a consensus conference on the afferent limb of rapid response systems. Resuscitation 2010; 81: 375-82; http://dx.doi.org/10.1016/j.resuscitation.2009.12.008
  • Smith GB, Prytherch DR. An overview of the afferent limb. In: DeVita MA Hillman K, Bellomo R (eds.). Textbook of Rapid Response Systems: concept and implementation. Springer Science Business Media, LLC 2011; http://dx.doi.org/10.1007/978-0-387-92853-1_16
  • Neff T. Routine oximetry. A fifth vital sign? Chest 1988; 94: 227; http://dx.doi.org/10.1378/chest.94.2.227a
  • Morgan RJM, Williams F, Wright MM. An early warning scoring system for detecting developing critical illness. Clin Intensive Care 1997; 8: 100
  • Evans D, Hodgkinson B, Berry J. Vital signs in hospital patients: a systematic review. Int J Nurs Stud 2001; 38: 643-50; http://dx.doi.org/10.1016/S0020-7489(00)00119-X
  • Buist MD, Jarmolowski E, Burton PR, et al. Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital. Med J Aust 1999; 171: 22-5
  • Jones S, Mullally M, Sarah I. Bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an early warning score protocol. Crit Care Resusc 2011; 13: 83-8
  • Bellomo R, Ackerman M, Bailey M, et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med 2012; 40: 2349-61; http://dx.doi.org/10.1097/CCM.0b013e318255d9a0
  • Fagan K, Sabel A, Mehler PS, et al. Vital sign abnormalities, rapid response, and adverse outcomes in hospitalized patients. Am J Med Qual 2012; 27: 480-6; http://dx.doi.org/10.1177/1062860611436127
  • Odell M. Detection and management of the deteriorating ward patient: an evaluation of nursing practice. J Clin Nurs 2014; 24: 173-82; http://dx.doi.org/10.1111/jocn.12655
  • Cretikos MA, Bellomo R, Hillman K, et al. Respiratory rate: the neglected vital sign. Med J Aust 2008; 188: 657-9
  • Hogan J. Why don’t nurses monitor the respiratory rates of patients? Br J Nurs 2006; 15: 489-92; http://dx.doi.org/10.12968/bjon.2006.15.9.21087
  • Odell M. Are early warning scores the only way to rapidly detect and manage deterioration? Nurs Times 2010; 106: 24-6
  • Jansen JO, Cuthbertson BH. Detecting critical illness outside the ICU: the role of track and trigger systems. Curr Opin Crit Care 2010; 16: 184-90; http://dx.doi.org/10.1097/MCC.0b013e328338844e
  • Hourihan F, Bishop G, Hillman KM. The medical emergency team: a new strategy to identify and intervene in high risk patients. Clin Intensive Care 1995; 6: 269-72; http://dx.doi.org/10.3109/tcic.6.6.269.272
  • Lee A, Bishop G, Hillman KM, et al. The medical emergency team. Anaesth Intensive Care 1995; 23: 183-6
  • Goldhill DR, Worthington L, Mulcahy A, et al. The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia 1999; 4: 853-60; http://dx.doi.org/10.1046/j.1365-2044.1999.00996.x
  • Radeschi G, Penso R, Odetto L. METal provider course manual. Bologna: IRC Edizioni, 2008
  • Subbe CP, Kruger M, Rutherford P, et al. Validation of a modified Early Warning Score in medical admissions. QJM 2001; 94: 521-6; http://dx.doi.org/10.1093/qjmed/94.10.521
  • Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acute illness severity in the NHS. Report of a working party. London: RCP, 2012
  • Jones D, Lippert A, DeVita M, et al. What’s new with rapid response systems? Intensive Care Med 2015; 41: 315-7; http://dx.doi.org/10.1007/s00134-014-3567-2
  • Gao H, McDonnell A, Harrison DA, et al. Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward. Intensive Care Med 2007; 33: 667-79; http://dx.doi.org/10.1007/s00134-007-0532-3
  • Brown H, Terrence J, Vasquez P, et al. Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial. Am J Med 2014; 127: 226-32; http://dx.doi.org/10.1016/j.amjmed.2013.12.004
  • Cooper N, Forrest K, Cramp P. Chapter 1. Patients at risk. In: Essential guide to acute care. Oxford: Blackwell Publishing Ltd, BMJ Books, 2ndEdition, 2006
  • Trinkle RM, Flabouris A. Documenting Rapid Response System afferent limb failure and associated patient outcomes. Resuscitation 2011; 82: 810-4; http://dx.doi.org/10.1016/j.resuscitation.2011.03.019
  • Sakai T, Devita MA. Rapid response system. J Anesth 2009; 23: 403-8; http://dx.doi.org/10.1007/s00540-009-0778-8
  • Odell M, Victor C, Oliver D. Nurses’ role in detecting deterioration in ward patients: systematic literature review. J Adv Nurs 2009; 65: 1992-2006; http://dx.doi.org/10.1111/j.1365-2648.2009.05109.x
  • Pantazopoulos I, Tsoni A, Kouskouni E. Factors influencing nurses’ decisions to activate medical emergency teams. J Clin Nurs 2012; 21: 2668-78; http://dx.doi.org/10.1111/j.1365-2702.2012.04080.x
  • Bagshaw SM, Mondor EE, Scouten C, et al. Survey of nurses’ beliefs about the medical emergency team system in a canadian tertiary hospital. Am J Crit Care 2010; 19: 74-83; http://dx.doi.org/10.4037/ajcc2009532
  • Pusateri ME, Prior MM, Kiely SC. The role of the non-ICU staff nurse on a medical emergency team: perceptions and understanding. Am J Nurs 2011; 111: 22-9; http://dx.doi.org/10.1097/01.NAJ.0000398045.00299.64
  • Davies O, DeVita MA, Ayinla R. Barriers to activation of the rapid response system. Resuscitation 2014; 85: 1557-61; http://dx.doi.org/10.1016/j.ahj.2014.07.013
  • Radeschi G, Urso F, Campagna S, et al. Factors affecting attitudes and barriers to a medical emergency team among nurses and medical doctors: a multicenter survey. Resuscitation 2015; 88: 92-9; http://dx.doi.org/10.1016/j.resuscitation.2014.12.027

Statistics

Abstract: 2179 views
HTML: 1276 views
PDF: 3969 views

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.