Outcomes following changing from a two-tiered to a three-tiered hospital rapid response systemThe Concord Medical Emergency Team (MET) 2 Study Investigators
A A full list of study authors is available as Supplementary Material to this paper.
B Corresponding author. Winston Cheung, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia. Email: firstname.lastname@example.org
Australian Health Review - https://doi.org/10.1071/AH17105
Submitted: 18 April 2017 Accepted: 28 September 2017 Published online: 16 November 2017
Objectives The aim of the present study was to determine whether changing a hospital rapid response system (RRS) from a two-tiered to a three-tiered model can reduce disruption to normal hospital routines while maintaining the same overall patient outcomes.
Methods Staff at an Australian teaching hospital attending medical emergency team and cardiac arrest (MET/CA) calls were interviewed after the RRS was changed from a two-tiered to three-tiered model, and the results were compared with a study using the same methods conducted before the change. The main outcome measures were changes in: (1) the incident rate resulting from staff leaving normal duties to attend MET/CA calls; (2) the cardiac arrest rate, (3) unplanned intensive care unit (ICU) admission rates; and (4) hospital mortality.
Results We completed 1337 structured interviews (overall response rate 65.2%). The rate of incidents occurring as a result of staff leaving normal duties to attend MET/CA calls fell from 213.7 to 161.3 incidents per 1000 MET/CA call participant attendances (P < 0.001), but the rate of cardiac arrest and unplanned ICU admissions did not change significantly. Hospital mortality was confounded by the opening of a new palliative care ward.
Conclusion A three-tiered RRS may reduce disruption to normal hospital routines while maintaining the same overall patient outcomes.
What is known about the topic? RRS calls result in significant disruption to normal hospital routines because staff can be called away from normal duties to attend. The best staffing model for an RRS is currently unknown.
What does this paper add? The present study demonstrates, for the first time, that changing a hospital RRS from a two-tiered to a three-tiered model can reduce the rate of incidents reported by staff caused by leaving normal duties to attend RRS calls while maintaining the same overall patient outcomes.
What are the implications for practitioners? Hospitals could potentially reduce disruption to normal hospital routines, without compromising patient care, by changing to a three-tiered RRS.
Additional keywords: cardiopulmonary resuscitation, critical care, emergencies, heart arrest, hospital rapid response team, intensive care units.
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