Abstract
Introduction The clinical components of the rapid response system (RRS) are the afferent limb, to ensure identification of in-hospital patients who deteriorate and activation of a response, and the efferent limb, to provide the response. This review aims to evaluate the factors that influence the performance of the afferent limb in managing deteriorating ward patients and their effects on patient outcomes. Methods A systematic review was performed for the years 1995–2017 by employing five electronic databases. Articles were included assessing the ability of the ward staffs to monitor, recognize, and escalate care to patient deterioration. The findings were summarized using a narrative approach. Results Thirty-one studies met the inclusion criteria. The analysis revealed major themes enclosing several factors affecting management of patients having sudden deterioration. The monitoring and recognition process was conditioned by the lack of recording of physiological parameters, the influence of facilitators, including staff education and training, and barriers, including human and environmental factors, and poor compliance with the calling criteria. The escalation of care process highlighted the influence of cultural barriers and personal judgment on RRS activation. Mainly, delayed team calls were factors strongly associated with the increased risk of unplanned admissions to the intensive care unit and length of stay, hospital length of stay and mortality, and 30-day mortality. Conclusions A combination of factors affects the timely identification and response to sudden deterioration by general ward staffs, leading to suboptimal care of patients, delayed or failed activation of RRS teams, and increased risks of worsening outcomes. The research efforts and clinical involvement to improve the governance of the factors limiting the performance of the afferent limb may ensure proper management of hospitalized patients showing physiological deterioration.
Highlights
On general hospital wards, the timely treatment of patient deterioration before the onset of serious adverse events (SAEs) is achievable by alerting emergency teams of critical care clinicians. e Medical Emergency Team (MET) has been adopted, the first of these teams, in 1989 at the Liverpool Hospital in Sydney, Australia [1, 2], to supplement or replace the Cardiac Arrest Team (CAT) [3]
Critical Care Research and Practice e Rapid Response System (RRS) has been designed to detect and respond to deteriorating patients outside the intensive care unit (ICU) [8, 9]. e concept of patient deterioration has been first emphasized by Schein et al [12] by suggesting that derangement of clinical signs often anticipates cardiopulmonary arrest
Different factors may encourage or inhibit the effective use of the MET system by ward nurses [27]. e dynamic of the afferent limb relies on the interaction and collaboration between physicians and nurses with different clinical skills. e activity of these clinicians involves sequential passages: monitoring of vital signs and physiologic parameters, recognizing of patient deterioration, implementation of the treatment for at-risk patients, and the request for help with activation of RRS teams (Figure 1). is review aims to evaluate the factors that influence the performance of the afferent limb, affecting the ability to monitor, recognize, and escalate care to deteriorating ward patients, and their effects on patient outcomes
Summary
The timely treatment of patient deterioration before the onset of serious adverse events (SAEs) is achievable by alerting emergency teams of critical care clinicians. e Medical Emergency Team (MET) has been adopted, the first of these teams, in 1989 at the Liverpool Hospital in Sydney, Australia [1, 2], to supplement or replace the Cardiac Arrest Team (CAT) [3]. E afferent limb includes ward physicians and nurses to identify at-risk patients and to trigger a response based on the calling criteria. E RRS aims to reduce SAEs including cardiac arrest, unplanned admissions to the ICU, and death [8, 9]; the effectiveness of RRSs in improving patient outcomes remains controversial [18,19,20]. E activity of these clinicians involves sequential passages: monitoring of vital signs and physiologic parameters, recognizing of patient deterioration, implementation of the treatment for at-risk patients, and the request for help with activation of RRS teams (Figure 1). Is review aims to evaluate the factors that influence the performance of the afferent limb, affecting the ability to monitor, recognize, and escalate care to deteriorating ward patients, and their effects on patient outcomes Different factors may encourage or inhibit the effective use of the MET system by ward nurses [27]. e dynamic of the afferent limb relies on the interaction and collaboration between physicians and nurses with different clinical skills. e activity of these clinicians involves sequential passages: monitoring of vital signs and physiologic parameters, recognizing of patient deterioration, implementation of the treatment for at-risk patients, and the request for help with activation of RRS teams (Figure 1). is review aims to evaluate the factors that influence the performance of the afferent limb, affecting the ability to monitor, recognize, and escalate care to deteriorating ward patients, and their effects on patient outcomes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
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 call
