Journal of Korean Clinical Nursing Research (임상간호연구)

Hospital Nurses Association (병원간호사회)
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Factors Influencing the Activation Time of the Rapid Response Team

신속대응팀의 활성화 시간에 영향을 주는 요인

  • Han, Mi Ra (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Kang, Eun Hyoung (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Lee, Yong Suk (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Chang, Eun Ju (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Lee, Su Jeong (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Heo, Yoon A (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Namgung, Seo Hwa (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital) ;
  • Seo, Seo Hee (Department of Nursing, The Catholic University of Korea Seoul ST. Mary's Hospital)
  • 한미라 (가톨릭대학교 서울성모병원) ;
  • 강은형 (가톨릭대학교 서울성모병원) ;
  • 이용숙 (가톨릭대학교 서울성모병원) ;
  • 장은주 (가톨릭대학교 서울성모병원) ;
  • 이수정 (가톨릭대학교 서울성모병원) ;
  • 허윤아 (가톨릭대학교 서울성모병원) ;
  • 남궁서화 (가톨릭대학교 서울성모병원) ;
  • 서서희 (가톨릭대학교 서울성모병원)
  • Received : 2020.05.26
  • Accepted : 2020.06.23
  • Published : 2020.08.31
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Abstract

Purpose: The rapid response team is a patient safety system that detects symptoms and signs of deteriorating inpatients and provides intervention and treatment. This study analyzed the factors influencing the activation time of the team. Methods: This is a descriptive correlation study that analyzed the electronic medical records of patients activated by the rapid response team. The collection period was from January 2014 to December 2017. We analyzed 278 pieces of data activated by the rapid response team for patients aged 16 years or older at C University S Hospital in Seoul. We employed the SPSS 23.0 program for data analysis. Results: The reasons for activation of the rapid response team were oxygen saturation of less than 90.0%, other causes, and change in consciousness. The most common diagnosis of activated patients was respiratory failure (32.4%). The average activation time was 153.43±286.05 min. The activation time was shortest during convulsions (13.29±7.32 min). For patients with a history of kidney disease (B=0.58, p=.008), in case of surgery (B=0.55, p<.001), if the first symptom is mediated by the physician (B=0.53, p=.007) the active time is often extended. On the other hand, activation time is reduced when consciousness changes (B=-0.51, p=.002), especially when oxygen saturation is below 90.0% (B=-0.64, p<.001). Conclusion: Based on the results of the study, it is expected that patients deteriorating in the general ward would be recognized early, which will help in the effective activation of the rapid response team.

Keywords

References

  1. Simmonds T. Best-practice portocols: Implementing a rapid response system of care. Nursing Management. 2005;36(7):41-59. https://doi.org/10.1097/00006247-200507000-00010
  2. White K, Scott IA, Bernard A, McCulloch K, Vaux A, Joyce C, et al. Patient characteristics, interventions and outcomes of 1151 rapid response team activations in a tertiary hospital: A prospective study. Internal Medicine Journal. 2016;46(12):1398-1406. https://doi.org/10.1111/imj.13248
  3. Thomas K, VanOyen Force M, Rasmussen D, Dodd D, Whildin S. Rapid response team: Challenges, solutions, benefits. Critical Care Nurse. 2007;27(1):20-27. https://doi.org/10.4037/ccn2007.27.1.20
  4. Jones DA, DeVita MA, Bellomo R. Rapid-response teams. New England Journal of Medicine. 2011;365(2):139-146. https://doi.org/10.1056/nejmra0910926
  5. DeVita MA, Hillman K, Bellomo R, Odell M, Jones DA, Winters BD, et al, editors. Textbook of rapid response systems: Concept and implementation. Chem(CH): Springer Nature; 2017. p. 25-30. https://doi.org/10.1007/978-3-319-39391-9
  6. Subbe CP, Welch JR. Failure to rescue: Using rapid response systems to improve care of the deteriorating patient in hospital. Journal of Patient Safety and Risk Management. 2013;19(1):6-11. https://doi.org/10.1177%2F1356262213486451
  7. Andersen LW, Kim WY, Chase M, Berg KM, Mortensen SJ, Moskowitz A, et al. The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest. Resuscitation. 2016;98:112-117. https://doi.org/10.1016/j.resuscitation.2015.08.016
  8. Boerma LM, Reijners EP, Hessels RA, v Hooft MA. Risk factors for unplanned transfer to the intensive care unit after emergency department admission. The American Journal of Emergency Medicine. 2017;35(8):1154-1158. https://doi.org/10.1016/j.ajem.2017.03.019
  9. Heller AR, Mees ST, lauterwald B, Mees H, Benjamin L, Christian R, et al. Detection of deteriorating patients on surgical wards outside the ICU by an automated MEWS-based early warning system with paging functionality. Annals of Surgery. 2020;271(1):100-105. https://doi.org/10.1097/SLA.0000000000002830
  10. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation. 2018;128:191-197. https://doi.org/10.1016/j.resuscitation.2018.05.013
  11. Burrell E, Kapu A, Huggins E, Cole K, Fitzsimmons J, Collins N, et al. Dedicated, proactive, nurse practitioner rapid response team eliminating barriers. The Journal for Nurse Practitioners. 2020;16(1):e17-e20. https://doi.org/10.1016/j.nurpra.2019.07.013
  12. Barwise A, Thongprayoon C, Gajic O, Jensen J, Herasevich V, Pickering BW. Delayed rapid response team activation is associated with increased hospital mortality, morbidity, and length of stay in a tertiary care institution. Critical Care Medicine. 2016;44(1):54-63. https://doi.org/10.1097/CCM.0000000000001346
  13. Fernando SM, Readon PM, Bagshaw SM, Scales DC, Murphy K, Shen J, et al. Impact of nighttime rapid response team activation on outcomes of hospitalized patients with acute deterioration. Critical Care. 2018;22:67. https://doi.org/10.1186/s13054-018-2005-1
  14. Kwak HJ, Yun I, Kim SH, Sohn JW, Shin DH, Yoon HJ, et al. The extended rapid response system: 1-year experience in a university hospital. Journal of Korean Medical Science. 2014;29(3):423-430. https://doi.org/10.3346/jkms.2014.29.3.423
  15. Kim Y, Lee DS, Min H, Choi YY, Lee EY, Song I, et al. Effectiveness analysis of a part-time rapid response system during operation versus nonoperation. Critical Care Medicine. 2017;45(6):e592-e599. https://doi.org/10.1097/CCM.0000000000002314
  16. Oh TK, Kim SY, Lee DS, Min HJ, Choi YY, Lee EY, et al. A rapid response system reduces the incidence of in-hospital postoperative cardiopulmonary arrest: A retrospective study. Canadian Journal of Anesthesia. 2018;65(12):1303-1313. https://doi.org/10.1007/s12630-018-1200-5
  17. Ko BS, Lim TH, Oh JH, Lee YJ, Yun IA, Yang MS, et al. The effectiveness of a focused rapid response team on reducing the incidence of cardiac arrest in the general ward. Medicine. 2020;99(10):e19032. https://doi.org/10.1097/md.0000000000019032
  18. Brydges N, Mundie T. Rapid Response Team(RRT) in Critical Care. Springer. 2020:87-94. https://doi.org/10.1007/978-3-319-74588-6_9
  19. Kabrhel C, Rosovsky R, Channick R, Harshbarger S, Chang Y, Rosenfield K. A multidisciplinary pulmonary embolism response team: Initial 30-month experience with a novel approach to delivery of care to patients with submassive and massive pulmonary embolism. Chest. 2016;150(2):384-393. https://doi.org/10.1016/j.chest.2016.03.011
  20. Ju T, Al-Mashat M, Rivas L, Sarani B. Sepsis rapid response teams. Critical Care Clinics. 2018;34(2):253-258. https://doi.org/10.1016/j.ccc.2017.12.004
  21. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL, et al. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Quality & Safety in Health Care. 2004;13(4):251-254. https://doi.org/10.1136/qhc.13.4.251
  22. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94(10):521-526. https://doi.org/10.1093/qjmed/94.10.521
  23. Suh JH. Age range of pediatric emergency patients for optimal care in the situation of limited resources, [master's thesis]. Seoul: Ewha Womans University; 2018. p.1-117.
  24. Reardon PM, Fernando SM, Murphy K, Rosenberg E, Kyeremanteng K. Factors associated with delayed rapid response team activation. Journal of Critical Care. 2018;46:73-78. https://doi.org/10.1016/j.jcrc.2018.04.010
  25. Gupta S, Green C, Subramaniam A, Zhen LD, Low E, Tiruvoipati R. The impact of delayed rapid response call activation on patient outcomes. Journal of Critical Care. 2017;41:86-90. https://doi.org/10.1016/j.jcrc.2017.05.006
  26. DeVita MA, Hillman K, Bellomo R. Text book of rapid response system: Concept and implementation. New York(NY): Springer Science+Business Media; 2011. p. 115-116. https://doi.org/10.1007/978-0-387-92853-1
  27. Douw G, Huisman-de Waal G, van Zanten AR, van der Hoeven JG, Schoonhoven L. Capturing early signs of deterioration: The dutch-early-nurse-worry-indicator-score and its value in the Rapid Response System. Journal of Clinical Nursing. 2017;26 (17-18):2605-2613. https://doi.org/10.1111/jocn.13648
  28. Douw G, Schoonhoven L, Holwerda T, Huisman-de Waal G, van Zanten AR, van Achterberg T, et al. Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: A systematic review. Critical Care. 2015;19:230. https://doi.org/10.1186/s13054-015-0950-5
  29. Braaten JS. Hospital system barriers to rapid response team activation: A cognitive work analysis. American Journal of Nursing. 2015;115(2):22-32. https://doi.org/10.1097/01.naj.0000460672.74447.4a
  30. Chua WL, See MT, Legido-Quigley H, Jones D, Tee A, Liaw SY. Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: A systematic review. International Journal for Quality in Health Care. 2017;29(8):981-998. https://doi.org/10.1093/intqhc/mzx149