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BackgroundThe timely recognition and response to patients with clinical deteriorations constitute the afferent limb failure of a rapid response system (RRS). This area is a persistent problem in acute healthcare settings worldwide. In this study, we evaluated the effect of an educational programme on improving the nurses’ knowledge and performances in recognising and responding to clinical deterioration.MethodThe interactive web-based programme addressed three areas: (1) early detection of changes in vital signs; (2) performance of nursing assessment and interventions using airway, breathing, circulation, disability and expose/examine and (3) reporting clinical deterioration using identity, situation, background, assessment and recommendation. Sixty-seven registered nurses participated in the randomised control study. The experimental group underwent a 3 h programme while the control group received no intervention. Pretests and post-tests, a mannequin-based assessment and a multiple-choice knowledge questionnaire were conducted. We evaluated the participants’ performances in assessing, managing and reporting the deterioration of a patient using a validated performance tool.ResultsA significantly higher number of nurses from the experimental group than the control group monitored respiratory rates (48.2% vs 25%, p<0.05) and pulse rates (74.3% vs 37.5%, p<0.01) in the simulated environment, after the intervention. The post-test mean scores of the experimental group was significantly higher than the control group for knowledge (21.29 vs 18.28, p<0.001), performance in assessing and managing clinical deterioration (25.83 vs 19.50, p<0.001) and reporting clinical deterioration (12.83 vs 10.97, p<0.001).ConclusionsA web-based educational programme developed for hospital nurses to strengthen the afferent limb of the RRS significantly increased their knowledge and performances in assessing, managing and reporting clinical deterioration.

This is the fifth article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled \"Chat with the Authors\" calls every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with September's Evidence-Based Practice, Step by Step.

Rapid-response teams aim to care for inpatients in whom acute respiratory, neurologic, or cardiac insufficiency is developing. This review describes the prevalence and consequences of sudden critical illness outside the ICU and discusses the rationale for rapid-response systems. Rapid-response teams have been introduced to intervene in the care of patients with unexpected clinical deterioration. These teams are key components of rapid-response systems, which have been put in place because of evidence of “failure to rescue” with available clinical services, leading to serious adverse events. 1 A serious adverse event may be defined as an unintended injury that is due in part to delayed or incorrect medical management and that exposes the patient to an increased risk of death and results in measurable disability. 2 Rapid-response systems aim to improve the safety of hospital-ward patients whose condition is deteriorating. These systems . . .

To synthesize factors influencing the activation of the rapid response system (RRS) and reasons for suboptimal RRS activation by ward nurses and junior physicians. Nine electronic databases were searched for articles published between January 1995 and January 2016 in addition to a hand-search of reference lists and relevant journals. Published primary studies conducted in adult general ward settings and involved the experiences and views of ward nurses and/or junior physicians in RRS activation were included. Data on design, methods and key findings were extracted and collated. Thirty studies were included for the review. The process to RRS activation was influenced by the perceptions and clinical experiences of ward nurses and physicians, and facilitated by tools and technologies, including the sensitivity and specificity of the activation criteria, and monitoring technology. However, the task of enacting the RRS activations was challenged by seeking further justification, deliberating over reactions from the rapid response team and the impact of workload and staffing. Finally, adherence to the traditional model of escalation of care, support from colleagues and hospital leaders, and staff training were organizational factors that influence RRS activation. This review suggests that the factors influencing RRS activation originated from a combination of socio-cultural, organizational and technical aspects. Institutions that strive for improvements in the existing RRS or are considering to adopt the RRS should consider the complex interactions between people and the elements of technologies, tasks, environment and organization in healthcare settings.

Background Measures exist to improve early recognition of, and response to, deteriorating patients in hospital. However, deteriorating patients continue to go unrecognized. To address this, interventions have been developed that invite patients and relatives to escalate patient deterioration to a rapid response team (RRT). Objective To systematically review articles that describe these interventions and investigate their effectiveness at reducing preventable deterioration. Search strategy Following PRISMA guidelines, four electronic databases and two web search engines were searched to identify literature investigating patient and relative led escalation. Inclusion criteria Articles investigating the implementation or use of systems involving patients and relatives in the detection of clinical patient deterioration and escalation of patient care to address any clinical or non‐clinical outcomes were included. Articles’ eligibility was validated by a second reviewer (20%). Data extraction Data were extracted according to pre‐defined criteria. Data synthesis Narrative synthesis was applied to included studies. Main results Nine empirical studies and 36 grey literature articles were included in the review. Limited studies were conducted to establish the clinical effectiveness of patient and relative led escalation. Instead, studies investigated the impact of this intervention on health‐care staff and available resources. Although appropriate, this reflects the infancy of research in this area. Patients and relatives did not overwhelm resources by activating the RRT. However, they did activate it to address concerns unrelated to patient deterioration. Conclusions Activating a RRT may not be the most appropriate or cost‐effective method of resolving non‐life‐threatening concerns.

Rapid response systems (RRS) were introduced in the 1990s to address acute patient deterioration outside intensive care units, aiming to prevent adverse outcomes through timely assessment and intervention. While RRS have been widely adopted across many countries, their effectiveness and optimal implementation strategies continue to be debated. These uncertainties arise from differences in study designs, hospital settings, and implementation approaches, highlighting the challenges of implementing and evaluating such complex interventions. This review outlines the key steps for successful RRS implementation, explores strategies to overcome implementation barriers, and highlights strategies for continuous improvement and evaluation of established RRS initiatives.

To propose community response teams (CRTs) as a systematic managed care approach that applies rapid response principles to prevent clinical deterioration and reduce costs in outpatient settings. Conceptual framework analysis with evidence review. We analyzed structural parallels between hospital rapid response teams and community-based systems, reviewed evidence on early intervention for rising-risk patients, and examined implementation models for managed care organizations. CRTs can leverage existing care management infrastructure while focusing on rising-risk patients identified through predictive analytics rather than traditional high-cost populations. Multisite implementation demonstrates significant improvements in patient outcomes, chronic disease control, and reduced emergency department visits and hospitalizations, enabling shared savings models that fully fund proactive interventions. CRTs represent a paradigm shift in managed care population health management, providing a scalable, cost-effective approach to preventing avoidable clinical deterioration while generating measurable return on investment through reduced medical expenditures.

Recognition of clinically deteriorating hospitalized patients with activation of rapid response (RR) systems can prevent patient harm. Patients with limited English proficiency (LEP), however, experience less benefit from RR systems than do their English-speaking counterparts. To improve outcomes among hospitalized LEP patients experiencing clinical deteriorations. Quasi-experimental pre-post design using quality improvement (QI) statistics. All adult hospitalized non-intensive care patients with LEP who were admitted to a large academic medical center from May 2021 through March 2023 and experienced RR system activation were included in the evaluation. All patients included after May 2022 were exposed to the intervention. Implementation of a modified RR system for LEP patients in May 2022 that included electronic dashboard monitoring of early warning scores (EWSs) based on electronic medical record data; RR nurse initiation of consults or full RR system activation; and systematic engagement of interpreters. Process of care measures included monthly rates of RR system activation, critical response nurse consultations, and disease severity scores prior to activation. Main outcomes included average post-RR system activation length of stay, escalation of care, and in-hospital mortality. Analyses used QI statistics to identify special cause variation in pre-post control charts based on monthly data aggregates. In total, 222 patients experienced at least one RR system activation during the study period. We saw no special cause variation for process measures, or for length of hospitalization or escalation of care. There was, however, special cause variation in mortality rates with an overall pre-post decrease in average monthly mortality from 7.42% (n = 8/107) to 6.09% (n = 7/115). In this pilot study, prioritized tracking, utilization of EWS-triggered evaluations, and interpreter integration into the RR system for LEP patients were feasible to implement and showed promise for reducing post-RR system activation mortality.

Improving early recognition and treatment of sepsis is key to decreasing patient mortality. The current study investigates barriers and facilitators to timely and appropriate sepsis care from the perspectives of care team members across different roles at a large academic health system. We held focus groups with frontline staff involved with sepsis care grouped by roles, including nurses, physicians, residents, pharmacists, laboratory staff, and members of an interdisciplinary sepsis rapid response team. Surveys were distributed to participants unable to attend a focus group session. Two researchers independently coded interview transcripts and survey responses, and mapped codes onto the Consolidated Framework for Implementation Research. Twenty-two frontline staff participated in seven focus groups; six others completed supplementary surveys. We identified eighteen factors influencing sepsis care across four themes: (1) sepsis detection; (2) approach to sepsis care; (3) team dynamics; (4) awareness of sepsis protocols, best practices, and performance. This study adds important insights on how team dynamics and environmental pressures affect sepsis care delivery. By including multiple roles in our sample, this study provides unique insight regarding how the lack of shared mental models troubles sepsis care delivery. Future efforts to optimize sepsis care should focus on assessing team dynamics and developing interventions to improve these shared understandings and communication across roles. •We held focus groups of frontline workers delivering sepsis care separated by role.•We mapped findings onto Consolidated Framework for Implementation Research (CFIR).•Barriers included communication issues and lack of shared mental models.•Efforts to improve sepsis care should take into consideration team dynamics.•Sepsis is complex and requires clear role designation and seamless communication.

Background Family-activated medical emergency teams (MET) have the potential to improve the timely recognition of clinical deterioration and reduce preventable adverse events. Adoption of family-activated METs is hindered by concerns that the calls may substantially increase MET workload. We aimed to develop a reliable process for family activated METs and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU). Methods The setting was our free-standing children's hospital. We partnered with families to develop and test an educational intervention for clinicians and families, an informational poster in each patient room and a redesigned process with hospital operators who handle MET calls. We tracked our primary outcome of count of family-activated MET calls on a statistical process control chart. Additionally, we determined the association between family-activated versus clinician-activated MET and transfer to the ICU. Finally, we compared the reason for MET activation between family calls and a 2:1 matched sample of clinician calls. Results Over our 6-year study period, we had a total of 83 family-activated MET calls. Families made an average of 1.2 calls per month, which represented 2.9% of all MET calls. Children with family-activated METs were transferred to the ICU less commonly than those with clinician MET calls (24% vs 60%, p<0.001). Families, like clinicians, most commonly called MET for concerns of clinical deterioration. Families also identified lack of response from clinicians and a dismissive interaction between team and family as reasons. Conclusions Family MET activations were uncommon and not a burden on responders. These calls recognised clinical deterioration and communication failures. Family activated METs should be tested and implemented in hospitals that care for children.