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Evaluating pre-rapid response team clinical escalations using a bidirectional messaging system in a tertiary hospital
Chris Zhao1, Nayana Khurana1, Junyan Zhao1
1Austin Health, Australia.
Background:
Pre-rapid response team (pre-RRT) systems are designed to facilitate early recognition and management of deteriorating hospitalised patients. In 2022, our institution implemented a novel role-based asynchronous messaging platform to support urgent clinical review (UCR) activations.
Objectives:
To describes the frequency, timing, nature, and appropriateness of UCR activations and evaluates utilisation of the communication platform.
Methods:
A retrospective observational study was conducted including all UCR messages sent via a role-based communication system at a tertiary Australian hospital between January and June 2024. Message metadata were analysed to describe activity patterns and response times. A systematic sample of every fifth UCR message underwent detailed review to assess appropriateness and reasons for escalation.
Results:
During the six-month study period, 27 401 UCR messages were sent, representing a median of 182 (interquartile range: 164-201) activations per day. Activations demonstrated marked diurnal variation, peaking during nursing handover and routine observation periods. Median time to first written response was 9 min (interquartile range: 2-26). Detailed review of 5524 messages found that 99.6% were sent by nursing staff and 98.6% were directed to medical teams. Most reviewed messages (96.6%) were appropriate UCR-related communications, while only 3.4% were unrelated to the escalation process. Tachycardia (22.3%), hypotension (14.4%), and tachypnoea (12.2%) were the most common physiological triggers. Clinical concerns including uncontrolled pain, possible cardiac ischaemia, and bleeding were also frequent reasons for escalation.
Conclusions:
Pre-RRT activations represent a substantial component of hospital clinical workload, with approximately 1000 UCR events occurring each week. A role-based asynchronous messaging platform enabled granular communication, an average medical response time of between 9 and 14 min, and was used appropriately in the vast majority of cases. These findings provide insights into the operational burden of pre-RRT systems and may inform future strategies to optimise escalation pathways, clinician workload, and patient safety.
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