Resuscitation
Volume 81, Issue 4 , Pages 375-382 , April 2010

“Identifying the hospitalised patient in crisis”—A consensus conference on the afferent limb of Rapid Response Systems

  • Michael A. DeVita

      Affiliations

    • West Penn Allegheny Health System, Pittsburgh, PA, USA
    • ,
  • Gary B. Smith

      Affiliations

    • Queen Alexandra Hospital, Portsmouth, UK
    • University of Bournemouth, Bournemouth, UK
    • Corresponding Author InformationCorresponding author at: Department of Critical Care, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK. Tel.: +44 2392 286306; fax: +44 2392 286326.
    • ,
  • Sheila K. Adam

      Affiliations

    • University College London Hospitals NHS Foundation Trust, London, UK
    • ,
  • Inga Adams-Pizarro

      Affiliations

    • Maryland Patient Safety Center, Elkridge, MD, USA
    • ,
  • Michael Buist

      Affiliations

    • University of Tasmania Rural Clinical School, Tasmania, Australia
    • ,
  • Rinaldo Bellomo

      Affiliations

    • Austin Hospital, Heidelberg, Victoria, Australia
    • ,
  • Robert Bonello

      Affiliations

    • University of Minnesota & Minneapolis VA Medical Center, Minneapolis, MN, USA
    • ,
  • Erga Cerchiari

      Affiliations

    • Maggiore Hospital, Bologna, Italy
    • ,
  • Barbara Farlow

      Affiliations

    • Patients for Patient Safety Canada, Mississauga, Ontario, Canada
    • ,
  • Donna Goldsmith

      Affiliations

    • Austin Health, Heidelberg, Victoria, Australia
    • ,
  • Helen Haskell

      Affiliations

    • Mothers Against Medical Error, Columbia, SC, USA
    • ,
  • Kenneth Hillman

      Affiliations

    • University of New South Wales & The Simpson Centre for Health Services Research, Liverpool, New South Wales, Australia
    • ,
  • Michael Howell

      Affiliations

    • Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
    • ,
  • Marilyn Hravnak

      Affiliations

    • University of Pittsburgh, Pittsburgh, PA, USA
    • ,
  • Elizabeth A. Hunt

      Affiliations

    • The Johns Hopkins University School of Medicine, Baltimore, MD, USA
    • ,
  • Andreas Hvarfner

      Affiliations

    • University Hospital, Lund, Sweden
    • ,
  • John Kellett

      Affiliations

    • Nenagh Hospital, Nenagh, County Tipperary, Ireland
    • ,
  • Geoffrey K. Lighthall

      Affiliations

    • Stanford University School of Medicine, Stanford, CA, USA
    • ,
  • Anne Lippert

      Affiliations

    • Danish Institute for Medical Simulation, Herlev Hospital, Herlev, Denmark
    • ,
  • Freddy K. Lippert

      Affiliations

    • Emergency Medicine and Emergency Medical Services, Head Office, The Capital Region of Denmark, Denmark
    • ,
  • Razeen Mahroof

      Affiliations

    • John Radcliffe Hospital, Oxford, UK
    • ,
  • Jennifer S. Myers

      Affiliations

    • University of Pennsylvania, Philadelphia, PA, USA
    • ,
  • Mark Rosen

      Affiliations

    • North Shore University Hospital and Long Island Jewish Medical Center, New York, NY, USA
    • ,
  • Stuart Reynolds

      Affiliations

    • University of Toronto, Toronto, Ontario, Canada
    • ,
  • Armando Rotondi

      Affiliations

    • University of Pittsburgh School of Medicine & Department of Veterans Affairs, Pittsburgh, PA, USA
    • ,
  • Francesca Rubulotta

      Affiliations

    • Department of Anaethesia, Imperial College, St Mary's Hospital, London, UK
    • ,
  • Bradford Winters

      Affiliations

    • The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Received 2 November 2009 ,Revised 2 December 2009 ,Accepted 12 December 2009.

References 

  1. McQuillan P, Pilkington S, Allan A, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998;316:1853–1858
  2. Buist M, Bernard S, Nguyen TV, Moore G, Anderson J. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004;62:137–141
  3. Sax FL, Charlson ME. Medical patients at high risk for catastrophic deterioration. Crit Care Med. 1987;15:510–515
  4. Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98:1388–1392
  5. Hillman KM, Bristow PJ, Chey T, et al. Antecedents to hospital deaths. Intern Med J. 2001;31:343–348
  6. Hillman KM, Bristow PJ, Chey T, et al. Duration of life-threatening antecedents prior to intensive care admission. Intensive Care Med. 2002;28:1629–1634
  7. Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom—the ACADEMIA study. Resuscitation. 2004;62:275–282
  8. Chellel A, Fraser J, Fender V, et al. Nursing observations on ward patients at risk of critical illness. Nurs Times. 2002;98:36–39
  9. Jacques T, Harrison GA, McLaws ML, Kilborn G. Signs of critical conditions and emergency responses (SOCCER): a model for predicting adverse events in the inpatient setting. Resuscitation. 2006;69:175–183
  10. McGain F, Cretikos MA, Jones D, et al. Documentation of clinical review and vital signs after major surgery. MJA. 2008;189:380–383
  11. Hillman K, Parr M, Flabouris A, Bishop G, Stewart A. Redefining in-hospital resuscitation: the concept of the medical emergency team. Resuscitation. 2001;48:105
  12. DeVita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34:2463–2478
  13. Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32:916–921
  14. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324:387–390
  15. Buist M, Harrison J, Abaloz E, Van DS. Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. BMJ. 2007;335:1210–1212
  16. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13:251–254
  17. Dacey MJ, Mirza ER, Wilcox V, et al. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med. 2007;35:2076–2082
  18. Rotondi AJ, Kvetan V, Carlet J, Sibbald WJ. Consensus conferences in critical care medicine. Methodologies and impact. Crit Care Clin. 1997;13:417–439
  19. Peberdy MA, Cretikos M, Abella BS, et al. Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: an Utstein-style scientific statement. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Resuscitation. 2007;75:412–433
  20. Oxford English Dictionary. In: Simpson J, Weiner E, editors. 2nd ed. Oxford: Oxford University Press.
  21. Franklin C, Mathew J. Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med. 1994;22:244–247
  22. Jones AE, Yiannibas V, Johnson C, Kline JA. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. Chest. 2006;130:941–946
  23. Smith GB, Prytherch DR, Schmidt PE, Featherstone PI. Review and performance evaluation of aggregate weighted ‘track and trigger’ systems. Resuscitation. 2008;77:170–179
  24. Smith GB, Prytherch DR, Schmidt PE, Featherstone PI, Higgins B. A review, and performance evaluation, of single-parameter “track and trigger” systems. Resuscitation. 2008;79:11–21
  25. Cretikos M, Chen J, Hillman K, et al. The objective medical emergency team activation criteria: a case-control study. Resuscitation. 2007;73:62–72
  26. Goldhill DR, White SA, Sumner A. Physiological values and procedures in the 24h before ICU admission from the ward. Anaesthesia. 1999;54:529–534
  27. Hravnak M, Edwards L, Clontz A, Valenta C, Devita MA, Pinsky MR. Defining the incidence of cardiorespiratory instability in patients in step-down units using an electronic integrated monitoring system. Arch Intern Med. 2008;168:1300–1308
  28. Bell MB, Konrad D, Granath F, Ekbom A, Martling CR. Prevalence and sensitivity of MET-criteria in a Scandinavian University Hospital. Resuscitation. 2006;70:66–73
  29. Fuhrmann L, Lippert A, Perner A, Ostergaard D. Incidence, staff awareness and mortality of patients at risk on general wards. Resuscitation. 2008;77:325–330
  30. Smith GB, Prytherch DR, Schmidt PE, et al. Should age be included as a component of track and trigger systems used to identify sick adult patients?. Resuscitation. 2008;78:109–115
  31. Goldhill DR, McNarry AF, Mandersloot G, McGinley A. A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia. 2005;60:547–553
  32. Paterson R, MacLeod DC, Thetford D, et al. Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit. Clin Med. 2006;6:281–284
  33. Skrifvars MB, Nurmi J, Ikola K, Saarinen K, Castren M. Reduced survival following resuscitation in patients with documented clinically abnormal observations prior to in-hospital cardiac arrest. Resuscitation. 2006;70:215–222
  34. Kellett J, Deane B. The Simple Clinical Score predicts mortality for 30 days after admission to an acute medical unit. QJM. 2006;99:771–781
  35. Kellett J, Deane B, Gleeson M. Derivation and validation of a score based on hypotension, oxygen saturation, low temperature, ECG changes and loss of independence (HOTEL) that predicts early mortality between 15min and 24h after admission to an acute medical unit. Resuscitation. 2008;78:52–58
  36. Watkinson PJ, Barber VS, Price JD, Hann A, Tarassenko L, Young JD. A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients. Anaesthesia. 2006;61:1031–1039
  37. Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J. 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;171:22–25
  38. Downey AW, Quach JL, Haase M, Haase-Fielitz A, Jones D, Bellomo R. Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias. Crit Care Med. 2008;36:477–481
  39. Chen J, Bellomo R, Flabouris A, Hillman K, Finfer S. The relationship between early emergency team calls and serious adverse events. Crit Care Med. 2009;37:148–153
  40. National Institute for Health and Clinical Excellence: acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. NICE clinical guideline No 50. London; 2007.
  41. Young D, Griffiths J. Clinical trials of monitoring in anaesthesia, critical care and acute ward care: a review. Br J Anaesth. 2006;97:39–45
  42. Moller JT, Johannessen NW, Espersen K, et al. Randomized evaluation of pulse oximetry in 20,802 patients. II. Perioperative events and postoperative complications. Anesthesiology. 1993;78:445–453
  43. Moller JT, Pedersen T, Rasmussen LS, et al. Randomized evaluation of pulse oximetry in 20,802 patients. I. Design, demography, pulse oximetry failure rate, and overall complication rate. Anesthesiology. 1993;78:436–444
  44. 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;33:667–679
  45. Subbe CP, Gao H, Harrison DA. Reproducibility of physiological track-and-trigger warning systems for identifying at-risk patients on the ward. Intensive Care Med. 2007;33:619–624
  46. Prytherch DR, Smith GB, Schmidt P, et al. Calculating early warning scores-A classroom comparison of pen and paper and hand-held computer methods. Resuscitation. 2006;70:173–178
  47. Mohammed M, Hayton R, Clements G, Smith G, Prytherch D. Improving accuracy and efficiency of early warning scores in acute care. Br J Nurs. 2009;18:18–24
  48. Groarke JD, Gallagher J, Stack J, et al. Use of an admission early warning score to predict patient morbidity and mortality and treatment success. Emerg Med J. 2008;25:803–806
  49. McBride J, Knight D, Piper J, Smith GB. Long-term effect of introducing an early warning score on respiratory rate charting on general wards. Resuscitation. 2005;65:41–44
  50. Odell M, Rechner IJ, Kapila A, et al. The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards. Resuscitation. 2007;74:470–475
  51. Oakey RJ, Slade V. Physiological observation track and trigger system. Nurs Stand. 2006;20:48–54
  52. Smith GB, Prytherch DR, Schmidt P, et al. Hospital-wide physiological surveillance-a new approach to the early identification and management of the sick patient. Resuscitation. 2006;71:19–28
  53. Tarassenko L, Hann A, Young D. Integrated monitoring and analysis for early warning of patient deterioration. Br J Anaesth. 2006;97:64–68
  54. Prytherch DR, Sirl JS, Schmidt P, Featherstone PI, Weaver PC, Smith GB. The use of routine laboratory data to predict in-hospital death in medical admissions. Resuscitation. 2005;66:203–207
  55. Prytherch DR, Sirl JS, Weaver PC, Schmidt P, Higgins B, Sutton GL. Towards a national clinical minimum data set for general surgery. Br J Surg. 2003;90:1300–1305
  56. Sleiman I, Morandi A, Sabatini T, et al. Hyperglycemia as a predictor of in-hospital mortality in elderly patients without diabetes mellitus admitted to a sub-intensive care unit. J Am Geriatr Soc. 2008;56:1106–1110
  57. Henry OF, Blacher J, Verdavaine J, Duviquet M, Safar ME. Alpha 1-acid glycoprotein is an independent predictor of in-hospital death in the elderly. Age Ageing. 2003;32:37–42
  58. Rafferty AM, Clarke SP, Coles J, et al. Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records. Int J Nurs Stud. 2007;44:175–182
  59. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288:1987–1993
  60. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002;346:1715–1722
  61. Santiano N, Young L, Hillman K, et al. Analysis of medical emergency team calls comparing subjective to “objective” call criteria. Resuscitation. 2009;80:44–49
  62. http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Tools/ConditionHBrochureforPatientsandFamilies.htm. Accessed 24/05/09.
  63. Ray EM, Smith R, Massie S, et al. Family Alert: Implementing direct family activation of a pediatric rapid response team. Jt Comm J Qual Patient Saf. 2009;35:575–580
  64. Kellett J. Prognostication—the lost skill of medicine. Eur J Intern Med. 2008;19:155–164
  65. Andrews T, Waterman H. Packaging: a grounded theory of how to report physiological deterioration effectively. J Adv Nurs. 2005;52:473–481

☆ A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.12.008.

☆☆ This work was support by grants from: Agency for Healthcare Research and Quality, Department of Veterans Affairs, UPMC Center for Quality and Innovation, American College of Chest Physicians, and the American Association of Critical Care Nurses.

PII: S0300-9572(09)00639-X

doi: 10.1016/j.resuscitation.2009.12.008

Resuscitation
Volume 81, Issue 4 , Pages 375-382 , April 2010

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