'Score to Door Time', a benchmarking tool for rapid response systems: a pilot multi-centre service evaluation

Area of Science:

• Critical Care Medicine
• Health Services Research
• Patient Safety

Background:

• Rapid Response Systems (RRS) aim to improve care for deteriorating patients on general wards by enabling timely intensive care unit (ICU) admission.
• Current quality assurance lacks a standardized tool for evaluating the efficiency of ICU admission processes.
• This study addresses the need for a benchmarking tool to assess RRS efficiency.

Purpose of the Study:

• To develop and validate a tool for analyzing the efficiency of ICU admission processes.
• To quantify delays in ICU admissions using the 'Score to Door Time' metric.
• To identify factors contributing to delays in ICU admissions.

Main Methods:

• A pilot multicenter service evaluation involving 17 ICUs across five countries (UK, Ireland, Denmark, USA, Australia).
• Utilized the VitalPAC™ Early Warning Score (a track and trigger system) to record physiological abnormalities.
• Measured 'Score to Door Time' (time from initial abnormality to ICU admission) and collected qualitative feedback on delay causes.

Main Results:

• Median 'Score to Door Time' was 4 hours 10 minutes for 177 admissions; 71% of admissions were deemed delayed.
• Time from trigger to RRS activation was a median of 47 minutes; time from call-out to ICU admission was a median of 2 hours 45 minutes.
• Predictors of longer 'Score to Door Time' included being in a UK center, higher APACHE II scores, and older age; APACHE II scores >20 were associated with longer delays.

Conclusions:

• 'Score to Door Time' appears largely independent of patient illness severity, suggesting organizational factors drive delays.
• The 'Score to Door Time' metric can serve as a valuable benchmarking tool for RRS.
• This tool helps delineate avoidable organizational delays in critical care for at-risk patients.