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Abstract

Rapid Response Systems (RRS) improve patient outcomes at large medical centers. Little is known about how RRS are used in other medical settings. The purpose of this exploratory study was to describe RRS events at a long-term acute care hospital (LTACH). We conducted a retrospective review of 71 RRS event records at an urban 50-bed Midwestern LTACH. Measures included demographic data, triggering mechanisms, contextual factors, mechanism factors, and clinical outcomes. Of patients who experienced a RRS event, median age was 71 (62, 80) years; 52.1% were female; most (n = 49, 69%) were “full code.” Most (n = 41, 58%) events occurred during the daytime. The most common trigger was “mental status changes/unresponsiveness.” Registered nurses were the most frequent activator (n = 19, 26.8%) and responders (n = 63, 60.6%). Median duration of RRS events was 14 (6, 25) minutes. Most patients stabilized and their condition improved (n = 54, 76.1%). RRS can be expanded and modified to the LTACH population.

Keywords

rapid response systems rapid response teams long-term acute care hospital

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References

Azevedo

L. C.

Choi

Simmonds

Davidow

Bagshaw

S. M.

(2014). Incidence and long-term outcomes of critically ill adult patients with moderate-to-severe diabetic ketoacidosis: Retrospective matched cohort study. Journal of Critical Care, 29(6), 971–977. https://doi.org/10.1016/j.jcrc.2014.07.034

Berwick

D. M.

(2008). The science of improvement. Journal of the American Medical Association, 299(10), 1182–1184. https://doi.org/10.1001/jama.299.10.1182

Berwick

D. M.

Calkins

D. R.

McCannon

C. J.

Hackbarth

A. D.

(2006). The 100,000 lives campaign: Setting a goal and a deadline for improving health care quality. Journal of the American Medical Association, 295(3), 324–327. https://doi.org/295/3/324

Blackwood

Wilson-Barnett

(2007). The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: A quasi-experimental study. International Journal of Nursing Studies, 44(2), 209–226. https://doi.org/10.1016/j.ijnurstu.2005.11.031

Blodgett

T. J.

Sheets

(2021). Perceptions of a nurse-driven urinary catheter removal protocol in a hospital setting. Clinical Nurse Specialist, 35(2), 73–79. https://doi.org/10.1097/nur.0000000000000579

Bunch

J. L.

Groves

P. S.

Perkhounkova

(2018). Realistic evaluation of a rapid response system: Context, mechanisms, and outcomes. Western Journal of Nursing Research. Advance online publication. https://doi.org/10.1177/0193945918776310

Chan

P. S.

Jain

Nallmothu

B. K.

Berg

R. A.

Sasson

(2010). Rapid response teams: A systematic review and meta-analysis. Archives of Internal Medicine, 170(1), 18–26. https://doi.org/10.1001/archinternmed.2009.424

Chen

Bellomo

Hillman

Flabouris

Finfer

(2010). Triggers for emergency team activation: A multicenter assessment. Journal of Critical Care, 25(2), 359.E351–357. https://doi.org/10.1016/j.jcrc.2009.12.011

Churpek

M. M.

Edelson

D. P.

Lee

J. Y.

Carey

Snyder

, & American Heart Association’s Get With the Guidelines-Resuscitation Investigators. (2017). Association between survival and time of day for rapid response team calls in a national registry. Critical Care Medicine, 45(10), 1677–1682. https://doi.org/10.1097/CCM.0000000000002620

10.

DeVita

M. A.

Hillman

Bellomo

Odell

Jones

D. A.

Winters

B. D.

Lighthall

G. K.

(2017). Textbook of rapid response systems: Concept and implementation. Springer.

11.

DiPietro

E. A.

Prestwich

Swearingen

(2014). Medical emergency team: Transitioning from an external response team to an internal response team. Rehabilitation Nursing, 39(2), 94–101. https://doi.org/10.1002/rnj.99;1710.1002/rnj.99

12.

Dunn

Quinn

Corbridge

Kapella

Eldeirawi

Steffen

Collins

(2019). A latent class analysis of prolonged mechanical ventilation patients at a long-term acute care hospital: Subtype differences in clinical outcomes. Heart Lung, 48(3), 215–221. https://doi.org/10.1016/j.hrtlng.2019.01.001

13.

Eskildsen

M. A.

(2007). Long-term acute care: A review of the literature. Journal of the American Geriatrics Society, 55(5), 775–779. https://doi.org/10.1111/j.1532-5415.2007.01162.x

14.

Fernando

S. M.

Reardon

P. M.

Bagshaw

S. M.

Scales

D. C.

Murphy

Shen

Tanuseputro

Heyland

D. K.

Kyeremanteng

(2018). Impact of nighttime rapid response team activation on outcomes of hospitalized patients with acute deterioration. Critical Care, 22(1), 67. https://doi.org/10.1186/s13054-018-2005-1

15.

Harris

P. A.

Taylor

Thielke

Payne

Gonzalez

Conde

J. G.

(2009). Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Information, 4(2), 377–381.

16.

Jones

Bates

Warrillow

Opdam

Goldsmith

Gutteridge

Bellomo

(2005). Circadian pattern of activation of the medical emergency team in a teaching hospital. Critical Care, 9(4), R303–R306. https://doi.org/10.1186/cc3537

17.

Kahn

J. M.

Benson

N. M.

Appleby

Carson

S. S.

Iwashyna

T. J.

(2010). Long-term acute care hospital utilization after critical illness. Journal of the American Medical Association, 303(22), 2253–2259. https://doi.org/10.1001/jama.2010.761

18.

Koenig

Demiralp

Saavoss

Zhang

(2015). The role of long-term acute care hospitals in treating the critically ill and medically complex: An analysis of nonventilator patients. Medical Care, 53(7), 582–590. https://doi.org/10.1097/mlr.0000000000000382

19.

Lee

Shin

Choi

Son

Jung

Y. K.

Hong

S.-B.

(2021). Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study. PLoS One, 16(2), e0247066. https://doi.org/10.1371/journal.pone.0247066

20.

Maharaj

Raffaele

Wendon

(2015). Rapid response systems: A systematic review and meta-analysis. Critical Care (London, England), 19(1), 254. https://doi.org/10.1186/s13054-015-0973-y

21.

Makam

A. N.

Nguyen

O. K.

Miller

M. E.

Shah

S. J.

Kapinos

K. A.

Halm

E. A.

(2020). Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer. BMC Health Services Research, 20(1), 1032. https://doi.org/10.1186/s12913-020-05847-6

22.

McCannon

C. J.

Hackbarth

A. D.

Griffin

F. A.

(2007). Miles to go: An introduction to the 5 Million Lives Campaign. Joint Commission Journal on Quality and Patient Safety, 33(8), 477–484. https://doi.org/S1553-7250(07)33051-1

23.

Medical Emergency Team End-of-Life Care Investigators. (2013). The timing of rapid-response team activations: A multicentre international study. Critical Care and Resuscitation: Journal of the Austrialasian Academy of Critical Care Medicine, 15(1), 15–20.

24.

Olson-Sitki

Kirkbride

Forbes

(2015). Evaluation of a nurse-driven protocol to remove urinary catheters: Nurses’ perceptions. Urologic Nursing, 35(2), 94–99.

25.

Rohlik

Pfeiffer

A. J.

Collins

C. E.

Parrett

C. R.

Kawai

(2021). Improving pediatric delirium assessment documentation and implementation of a nonpharmacologic delirium management bundle in the cardiovascular intensive care unit. Journal of Pediatric Nursing, 60, 168–176. https://doi.org/10.1016/j.pedn.2021.04.035

26.

Santiano

Young

Hillman

Parr

Jayasinghe

Baramy

L. S.

Stevenson

Heath

Chan

Hanger

(2009). Analysis of medical emergency team calls comparing subjective to “objective” call criteria. Resuscitation, 80(1), 44–49. https://doi.org/10.1016/j.resuscitation.2008.08.010

27.

Scott

Elliott

(2009). Implementation of a rapid response team: A success story. Critical Care Nurse, 29(3), 66–75. https://doi.org/10.4037/ccn2009802

28.

Singh

M. Y.

Vegunta

Karpe

Rai

(2020). Does the time of solitary rapid response team call affect patient outcome? Indian Journal of Critical Care Medicine, 24(1), 38–43. https://doi.org/10.5005/jp-journals-10071-23322

29.

The Medicare Payment Advisory Commission. (2015). Report to the congress: Long-term care hospital services. http://www.medpac.gov/documents/reports/chapter-11-long-term-care-hospital-services-(march-2015-report).pdf?sfvrsn=0

30.

Tirkkonen

Tamminen

Skrifvars

M. B.

(2017). Outcome of adult patients attended by rapid response teams: A systematic review of the literature. Resuscitation, 112, 43–52.

31.

Tirkkonen

Ylä-Mattila

Olkkola

K. T.

Huhtala

Tenhunen

Hoppu

(2013). Factors associated with delayed activation of medical emergency team and excess mortality: An Utstein-style analysis. Resuscitation, 84(2), 173–178. https://doi.org/10.1016/j.resuscitation.2012.09.021

32.

Vázquez-Calatayud

Oroviogoicoechea

Pittiglio

Pumar-Méndez

M. J.

(2020). Nurses’ protocol-based care decision-making: A multiple case study. Journal of Clinical Nursing, 29(23–24), 4806–4817. https://doi.org/https://doi.org/10.1111/jocn.15524

33.

Welch

(2021). Implementation of a proactive rapid response team nurse rounding protocol to address afferent limb failure in a mature rapid response system. Doctor of Nursing Practice Projects.

34.

Winters

B. D.

DeVita

(2011). Rapid response systems history and terminology. In DeVita

Hillman

Bellomo

(Eds.), Textbook of rapid response systems (pp. 3–12). Springer. https://doi.org/10.1007/978-0-387-92853-1_1

Rapid Response Systems at a Long-Term Acute Care Hospital

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