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Can proactive rapid response team rounding improve surveillance and reduce unplanned escalations in care? A
Valerie Danesh1, Donna Neff2, Terry L Jones3
1University of Texas at Austin, School of Nursing, 1710 Red River St., Mail Code D0100, Austin, TX 78701, United States.
Background:
Unplanned 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.
Objectives:
To 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.
Design:
Pre- and post Early Warning Score-guided proactive rapid response team model intervention.
Setting:
237-bed community hospital in the southeastern United States.
Participants:
All hospitalized adults (n = 12,148) during a pre- and post-intervention period.
Methods:
Logistic 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).
Results:
Unplanned 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.
Conclusions:
This 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.
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