Can proactive rapid response team rounding improve surveillance and reduce unplanned escalations in care? A controlled before and after study

Abstract

BackgroundUnplanned escalations manifest as a breakdown of hospital care attributable to clinician error through missed or delayed identification of physiological instability, ineffective treatment, or iatrogenic harm. ObjectivesTo examine the impact of an Early Warning Score-based proactive rapid response team model on the frequency of unplanned intra-hospital escalations in care compared with a rapid response team model based on staff nurse identification of vital sign derangements. DesignPre- and post Early Warning Score-guided proactive rapid response team model intervention. Setting237-bed community hospital in the southeastern United States. ParticipantsAll hospitalized adults (n = 12,148) during a pre- and post-intervention period. MethodsLogistic regressions used to examine the relationship between unplanned ICU transfers and rapid response team models (rapid response team vs. Early Warning Score-guided proactive rapid response team). ResultsUnplanned ICU transfers were 1.4 times more likely to occur during the rapid response team baseline period (OR = 1.392, 95% CI [1.017–1.905]) compared with the Early Warning Score-guided proactive rapid response team intervention period. ConclusionsThis study reports a difference in the frequency of unplanned escalations using different rapid response models, with fewer unplanned ICU transfers occurring during the use of Early Warning Score-guided proactive rapid response team model while accounting for differences in admission volumes, age, gender and comorbidities. Implementation of this model has implications for patient outcomes, hospital operations and costs.