Abstract
Studies of hospital performance highlight the problem of 'failure to rescue' in acutely ill patients. This is a deficiency strongly associated with serious adverse events, cardiac arrest, or death. Rapid response systems (RRSs) and their efferent arm, the medical emergency team (MET), provide early specialist critical care to patients affected by the 'MET syndrome': unequivocal physiological instability or significant hospital staff concern for patients in a non-critical care environment. This intervention aims to prevent serious adverse events, cardiac arrests, and unexpected deaths. Though clinically logical and relatively simple, its adoption poses major challenges. Furthermore, research about the effectiveness of RRS is difficult to conduct. Sceptics argue that inadequate evidence exists to support its widespread application. Indeed, supportive evidence is based on before-and-after studies, observational investigations, and inductive reasoning. However, implementing a complex intervention like RRS poses enormous logistic, political, cultural, and financial challenges. In addition, double-blinded randomised controlled trials of RRS are simply not possible. Instead, as in the case of cardiac arrest and trauma teams, change in practice may be slow and progressive, even in the absence of level I evidence. It appears likely that the accumulation of evidence from different settings and situations, though methodologically imperfect, will increase the rationale and logic of RRS. A conclusive randomised controlled trial is unlikely to occur.All truth passes through three stages.First, it is ridiculed.Second, it is violently opposed.Third, it is accepted as being self-evident.Arthur Schopenhauer (1788–1860), German philosopher
Highlights
Cardiac arrest teams have been around for decades, they often arrive at the end of the disease cascade, are unsuccessful in greater than 85% of patients, and patients so treated may survive the arrest but carry a high risk of hypoxic brain injury [9,10,11]
It would seem illogical for inadequately trained doctors to treat acutely ill patients instead of critical care physicians and nurses being responsible for their management [30]
Surveys have shown that a majority of nurses welcome the availability of an medical emergency team (MET) service, with 84% feeling that it improves their work environment and 65% considering it a factor when seeking a new job in an institution [39,40]
Summary
Specialists are so named because they are trained with particular skills and in-depth knowledge It would seem illogical for inadequately trained doctors to treat acutely ill patients instead of critical care physicians and nurses being responsible for their management [30]. An alternative, ‘pragmatic science’ approach by Berwick [47] promotes tracking effects over time, integrating detailed process knowledge into the work of interpretation, using small samples and short experimental cycles of change, and using multifactorial designs in evaluating system change According to this paradigm, common sense practices like bringing critical care expertise to acutely ill ward patients might not require randomised controlled trials and other evidence-based methodology before incorporation into practice. Once critical care physicians realise this is a new frontier for the specialty, we will be able to start filling these gaps step by step
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
