Mar 22, 2016
Rapid response systems (RRSs) have become a routine part of the
way patients are managed in general wards of acute care hospitals.
They have been adopted by national health and safety organisations
in North America, Canada, the United Kingdom and Australia and are
increasingly being used in other parts of the world.
Studies have almost universally shown significant reductions in
outcome indicators such as mortality (up to one third) and cardiac
arrest rates (up to 50%). However the validity of these outcomes is
questionable as most of these studies are single-centre,
before-and-after studies conducted by one or two clinical champions
in Rapid Response.
This presentation reveals that the implementation of an Intensivist
led Rapid Response Team in an Australian quaternary hospital did
not demonstrate such dramatic results. In fact, after one year of
service the standardised mortality ratio and the in-hospital
cardiac arrest rate remained similar.
The presentation explores some of the operational impacts of a RRS
including the replacement of critical thinking with reliance on
protocols and the progressive super-specialisation of medical
teams. Despite these impacts and relatively static patient outcome
data, the service has rapidly become an integral part of the
hospital.
Barriers between Intensive Care and ward staff have broken down and
quality outcome results have consistently shown ward nurses and
doctors feel better prepared, educated and supported in managing
clinical deterioration. These surprising results raise the
question; should we place more value in quality outcomes?