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Textbook of Rapid Response Systems - Concept and Implementation
Michael A. DeVita, Ken Hillman, Rinaldo Bellomo
Verlag Springer-Verlag, 2010
ISBN 9780387928531 , 438 Seiten
Format PDF
Kopierschutz Wasserzeichen
Preface
8
Contents
10
Contributors
14
Part I:RRSs and Patient Safety
20
Chapter 1: Rapid Response Systems History and Terminology
21
Principles
21
Terminology
24
Summary
26
References
26
Chapter 2: RRS’s General Principles
31
Introduction
31
Overview
32
Summary
35
References
35
Chapter 3: Measuring and Improving Safety
37
Introduction
37
Approach for the Organizational Evaluation of Patient Safety
38
Measuring Defects
41
How Might We Improve Safety?
44
A Framework to Improve Reliability
44
Why RRSs Can Improve Safety
51
Summary
51
References
51
Chapter 4: Integrating a Rapid Response System into a Patient Safety Program
54
Overview
54
Creating and Sustaining Safety
55
Definition and Relevance of Human Factors Engineering
55
The MET as a Driving Force for a Patient Safety Program
56
Root Cause Analysis
56
Failure Mode and Effect Analysis
58
Safety Culture and High-Reliability Organizations
59
Patient Safety Overall
60
Summary
61
References
61
Chapter 5: Acute Hospitalist Medicine and the Rapid Response System
63
History of the Hospitalist Movement
63
Models of Hospitalist Care
64
Benefits of Hospitalist Systems
65
Hospitalists as Acute Providers
66
Thoughts for the Future
67
References
68
Chapter 6: Medical Trainees and Patient Safety
70
Healthcare, Healthcare Facilities and Medical Trainees
70
The Healthcare Environment
71
Medical Trainees: The Undergraduate Years
71
Medical Trainees and Patient Safety: The First Few Years
72
Provision of Care for Identified Illnesses
72
Provision of Care for Medical Incidences
72
Improving Patient Safety in Institutions with Medical Trainees
73
Postgraduate Training and Specialization
74
Summary
75
References
75
Chapter 7: Rapid Response Systems: A Review of the Evidence
79
Introduction
79
Evaluating the Evidence
80
Identifying the Deteriorating Patient, the RRS Afferent Limb
81
The Efferent Limb: The Responding Team
82
The Rapid Response System: Is It Effective?
83
Summary
87
References
88
Chapter 8: Healthcare Systems and Their (Lack of.) Integration
93
Identification of the Seriously Ill At-Risk Patient
97
Response to the Seriously Ill Patient
97
Education
97
Evaluation
98
Support
98
References
99
Chapter 9: Creating Process and Policy Change in Healthcare
101
Introduction
101
Changing Healthcare Policy
101
References
106
Chapter 10: The Challenge of Predicting In-Hospital Cardiac Arrests and Deaths
107
Introduction
107
Organizational Crisis Theory: Hazards, Defenses and Latent Conditions
107
Iatrogenic Patient Death: Individual or Organizational Accident?
108
Can We Predict Hospital Iatrogenic Death?
111
Prevention of Futile Clinical Cycles with Hard Defenses
115
Communication Technology as a Hard Defense
117
References
118
Chapter 11: The Meaning of Vital Signs
122
Introduction
122
Pulse Rate
123
Blood Pressure
124
The Shock Index
125
Temperature
126
Respiratory Rate
128
Oximetry
128
Age and Vital Signs
129
Combining Vital Signs
132
Summary
132
References
133
Chapter 12: Matching Illness Severity with Level of Care
137
Evidence of Incorrect Placement of Patients
138
Definitions of Levels of Care
139
Identifying a Patient’s Level of Illness
140
Response to Acute Illness
141
Knowledge and Experience of Ward Staff
141
Potential Impact of Staffing Levels and Patient Flow on Outcomes
142
New Approaches to Matching Care with Patient Severity of Illness
142
New Patient Admission Processes
143
Early Treatment of Patients in the Emergency Department
143
New General Medicine Specialists
143
Rapid Response and Medical Emergency Teams
144
Better Decisions About Limitation of Care and Resuscitation
145
Summary
145
References
145
Chapter 13: Causes of Failure to Rescue
153
Introduction
153
Causes of FTR: Patient-Level Factors
155
Causes of FTR: Hospital- or System-Level Factors
158
Summary
160
References
160
Part II:Creating an RRS
163
Chapter 14: Impact of Hospital Size and Location on Feasibility of RRS
164
Introduction
164
Antecedents to Serious Adverse Events and Cardiac Arrests, and Criteria for RRS Activation
165
Models, Location and Size
165
Teaching Hospitals and Academic Medical Centers
166
Secondary Referral Centers
168
District General Hospitals
169
Small City Hospitals with an Intensive Care Unit
170
Summary
170
References
171
Chapter 15: Barriers to the Implementation of RRS
173
Introduction
173
Sources of Obstacles and Inertia
173
Foundations for System Change
176
Impediments Within the Hospital
177
Strategies to Overcome Hurdles
180
Summary
183
References
183
Chapter 16: An Overview of the Afferent Limb
186
Introduction
186
Improving the Function of the Afferent Limb
187
Improving Regular Monitoring and Assessment
187
Ensuring Vital Signs Measurements Are Accurate
188
Ensuring Vital Signs Measurements Are Accurately Recorded
188
Systems for Identifying the Sick or Deteriorating Patient
188
Aggregate Weighted Track-and-Trigger Systems
189
Single Parameter Track-and-Trigger Systems
190
Efficiency of Aggregate Weighted and Single Parameter Track-and-Trigger Systems
191
Other Clinical Observations that May Be Used to Trigger Rapid Response Systems
191
The Value of Monitoring Systems for Improving Detection of Critical Events in Low-Risk Populations
192
Calling for Assistance
193
The Role of Technology
193
Summary
194
References
194
Chapter 17: The Impact of Delayed RRS Activation
198
Background: Principles of the Rapid Response System
198
How Often Is RRS Activation Delayed?
199
What Are the Consequences of Delayed MET Activation?
200
How Should Delayed MET/RRT Activation Be Classified?
200
What Are the Causes of Delayed Response Activation?
201
How Can Delayed RRS Activation Be Avoided?
202
References
202
Chapter 18: The Case for Family Activation of the RRS
205
Introduction
205
The Origins of Patient- and Family-Activated Rapid Response: Condition H
206
Patient- and Family-Activated Rapid Response in Legislation, Accreditation, and Safety Organizations
207
Features of Patient- and Family-Activated Rapid Response Systems
208
Administration and Design
208
Patient Education
209
Triggering Criteria
209
Screening
209
Team Composition
210
Follow-Up and Data Collection
210
Gauging Success
210
Summary
211
References
212
Chapter 19: RRT: Nurse-Led RRSs
215
Identification of Hospital Resources
217
Nursing Leadership of RRTs
217
Support for the Nurse-Led Rapid Response Team
218
Communication Tools
218
Specific Protocols
219
Chain of Command Process
220
Benefits of a Nurse-Led RRT
222
Nursing Leadership and Mentoring After the RRT Call
224
Data Collection
224
Efficacy
227
Summary
227
References
228
Chapter 20: MET: Physician-Led RRSs
229
Introduction
229
Principles Underlying the Physician-Led MET
229
What is a Physician-Led MET?
230
What Does the Physician-Led MET Do?
232
Why Do Patients Need MET Calls?
234
What Are the Advantages and Disadvantages of Physician-Led METs?
235
References
236
Chapter 21: Pediatric RRSs
239
Introduction
239
Development and Operation of Pediatric Rapid Response Systems
240
Operational Team Responses: One-Tier Vs. Two-Tier
240
Recognition of Children with Critical Illness
241
Activation Triggers or Calling Criteria
241
Early Warning Scores
244
Outcomes of Some Pediatric Rapid Response Systems
246
Barriers to Implementation and Use of Rapid Response Systems
249
References
250
Chapter 22: Sepsis Response Team
252
Introduction
252
Early Goal-Directed Therapy
253
Implementing EGDT
255
Barriers to Implementation of EGDT
256
Summary
257
References
257
Chapter 23: Other Efferent Limb Teams: (BAT, DAT, M, H, and Trauma)
260
Basic Condition Response
261
Stroke Team
261
Trauma Team
262
Blood Administration Team
263
Chest Pain Team
263
Condition L (Lost Patient)
264
Difficult Airway Team
265
Pediatric Response Team
265
Condition M
266
Summary
267
Chapter 24: Other Efferent Limb Teams: Crisis Response for Obstetric Patients
269
Background and Justification
270
Design and Introduction
270
Staff Education
273
Response Team Training
274
Data Collection, Review, and Process Improvement
274
Usage of Condition O at Magee-Womens Hospital and Discussion
275
Summary
278
References
279
Chapter 25: Personnel Resources for Responding Teams
280
Introduction
280
Shortcomings of the Current System
281
How Organization Can Help in Crisis Response
282
Rethinking the Thinking
284
Structure
285
Human Resources
285
Activation of the RRS
286
The Ad Hoc Team
287
Changing the Existing Culture
288
Operating Room Crisis Teams
291
Summary
293
References
294
Chapter 26: Equipment, Medications, and Supplies for an RRS
295
Introduction
295
Institutional Oversight of Equipment
295
Personnel Response
297
Nursing Responder Equipment
304
Airway Equipment
304
Emergency Cart Standardization
305
Selecting an Emergency Cart
305
Need for Specialty Carts
306
House-Wide Crash Cart
308
Medication Selection
308
Pharmacy Emergency Cart Exchange Process
311
Restocking Medications in the Emergency Cart
311
Additional Methods for Supplying Emergency Medications
311
Obstacles to Implementation
312
Supply Standardization in the Emergency Carts
313
Summary
315
References
315
Chapter 27: The Administrative Limb
316
Why Is an Administrative Arm Needed?
316
What Should the Aims and Objectives of the Administrative Arm Be?
317
What Are the Components of the Administrative Limb?
318
The Intensive Care MET Administrative Group
319
Coordinating the Efferent Limb
321
Monitoring of Outcomes
321
Directing Future Research
321
Linking with the Clinical Governance Unit
322
The Role of Hospital Administration
322
References
323
Chapter 28: The Second Victim
324
Identifying Emotional Vulnerability and Recognizing Second Victims
325
Immediate Support During the Crisis
326
Support Long After the investigation
329
Emotional First Aid When Entire Teams Are Suffering
330
How to Formalize a Support Network
331
Putting It All Together
332
References
332
Part III:Monitoring of Efficacyand New Challenges
334
Chapter 29: RRSs in Teaching Hospitals
335
Introduction
335
Implementing RRSs in Teaching Hospitals
337
The Afferent Limb
337
The Efferent Limb
338
Hospital Culture and Management
338
Experiences with the RRS
339
Summary
340
References
340
Chapter 30: The Nurse’s View of RRS
342
Introduction
342
The Nurse’s Point of View
343
Steps to Ensuring a Successful Rapid Response System
344
Summary
345
References
345
Chapter 31: Resident Training and RRSs
347
Introduction
347
Origins of Rapid Response Systems: A Solution to a Real Problem
348
Concerns Over Implementing Medical Emergency Teams and Rapid Response Systems
349
Opportunities for Resident Involvement in METs/RRSs
350
A Win–Win Situation
351
What a Rapid Response System Can Teach Residents About Patient Safety
352
Summary
353
References
354
Chapter 32: Optimizing RRSs Through Simulation
356
Introduction
356
Unique Aspects of Hospital Crisis Teams
357
The Ad Hoc Nature of Crisis Teams
357
Simulation of Crises as Diagnostic Tool
357
What to Teach
358
Goals of Crisis Response Teams
359
Designated Roles: Assignment and Definition
359
Communication
364
Leadership
365
Debriefing
366
What to Measure
367
Summary
368
References
368
Chapter 33: Evaluating Effectiveness of Complex System Interventions
370
Characteristics of Complex System Interventions
370
Defining the Components of Complex System Evaluation
371
Choosing the Appropriate Research Methodology
373
Sub-system Interactions After a Complex System Intervention
375
Cost and Cost-Effectiveness
375
Interpreting Study Results of Complex System Interventions
376
Summary
377
References
377
Chapter 34: RRS Education for Ward Staff
380
Introduction
380
The Challenge for Ward Staff
381
The Evidence for Improving Education of Ward Staff in Acute Care
382
What General Ward Staff Need to Know
383
Challenges in Training Ward Staff in the Immediate Management of Acute Illness
385
Education Essential to the Implementation of an RRS
388
Current Initiatives in Acute Care Education
388
Short Courses in Acute Care
389
The Role of the Response Team in Educating Ward Staff
389
Evidence for Benefit in Acute Care Educational Interventions
390
Summary
390
References
391
Chapter 35: Standardized Process and Outcome Assessment Tool
395
Introduction
395
Standardization of the RRS Process
396
Initiating RRS
396
Data Collection
397
Evaluation
398
Outcome
399
Summary
400
References
400
Chapter 36: The Impact of RRSs on Choosing “Not-for-Resuscitation” Status
402
Background
402
Not-for-Resuscitation Decision Making
403
Rapid Response Teams and Not-for-Resuscitation Orders
404
Evidence for the Impact of Rapid Response Teams on Not-for-Resuscitation Orders
405
Summary
408
References
409
Chapter 37: The Costs and the Savings
412
The Cost of Adverse Events
412
Evolution of the Rapid Response System
413
Costs Associated with a Rapid Response System
414
Efferent Arm Costs
415
Afferent Arm Costs
416
Quality Improvement Arm Costs
417
Administrative Arm Costs
418
Societal Costs
419
Potential Hidden Costs
419
Savings
420
Hospital Savings
420
“Societal” Savings
422
Summary
423
References
423
Index
426