Christian P Subbe1, Jonathan Bannard-Smith2, Jacinda Bunch3, Ratapum Champunot4, Michael A DeVita5, Lesley Durham6, Dana P Edelson7, Isabel Gonzalez6, Christopher Hancock8, Rashan Haniffa9, Jillian Hartin10, Helen Haskell11, Helen Hogan12, Darly A Jones13, Cor J Kalkman14, Geoffrey K Lighthall15, James Malycha16, Melody Z Ni17, Alison V Phillips18, Francesca Rubulotta19, Ralph K So20, John Welch21. 1. School of Medical Sciences, Bangor University, Wales, UK. Electronic address: csubbe@hotmail.com. 2. Manchester Royal Infirmary, Manchester, UK. 3. The University of Iowa, College of Nursing, USA. 4. Buddhachinaraj Phitsanulok Hospital, Phitsanulok, Thailand. 5. Harlem Hospital Center, 506 Lenox Avenue, New York, USA. 6. North of England Critical Care Network (NoECCN), North Tyneside General Hospital, North Shields, UK. 7. Department of Medicine, University of Chicago, Chicago, IL, US. 8. NHS Wales, Innovation House, Bridgend Road, Llanharan CF72 9RP, UK. 9. Network for Improving Critical Care Systems and Training, UK. 10. Patient Emergency Response and Resuscitation Team, UCLH, London, UK. 11. Founder and President of the US Patient Group Mothers Against Medical Error; WHO Patient Safety Champion. 12. London School of Hygiene & Tropical Medicine, London, UK. 13. Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia. 14. UMC Utrecht, The Netherlands. 15. Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Dr. H3580, Stanford, CA, USA. 16. Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Level 3, Headley Way, Oxford, UK. 17. Imperial College, London, UK. 18. Patient Representative, UK. 19. Anaesthesia and Intensive Care Medicine, Centre for Peri-operative Medicine and Critical Care Charing Cross Hospital Intensive Care Unit, Imperial College NHS Trust, London, UK. 20. Department of Intensive Care, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, The Netherlands. 21. Consultant Nurse in Critical Care, University College London Hospital, London, UK.
Abstract
BACKGROUND: Clinically significant deterioration of patients admitted to general wards is a recognized complication of hospital care. Rapid Response Systems (RRS) aim to reduce the number of avoidable adverse events. The authors aimed to develop a core quality metric for the evaluation of RRS. METHODS: We conducted an international consensus process. Participants included patients, carers, clinicians, research scientists, and members of the International Society for Rapid Response Systems with representatives from Europe, Australia, Africa, Asia and the US. Scoping reviews of the literature identified potential metrics. We used a modified Delphi methodology to arrive at a list of candidate indicators that were reviewed for feasibility and applicability across a broad range of healthcare systems including low and middle-income countries. The writing group refined recommendations and further characterized measurement tools. RESULTS: Consensus emerged that core outcomes for reporting for quality improvement should include ten metrics related to structure, process and outcome for RRS with outcomes following the domains of the quadruple aim. The conference recommended that hospitals should collect data on cardiac arrests and their potential predictability, timeliness of escalation, critical care interventions and presence of written treatment goals for patients remaining on general wards. Unit level reporting should include the presence of patient activated rapid response and metrics of organizational culture. We suggest two exploratory cost metrics to underpin urgently needed research in this area. CONCLUSION: A consensus process was used to develop ten metrics for better understanding the course and care of deteriorating ward patients. Others are proposed for further development.
BACKGROUND: Clinically significant deterioration of patients admitted to general wards is a recognized complication of hospital care. Rapid Response Systems (RRS) aim to reduce the number of avoidable adverse events. The authors aimed to develop a core quality metric for the evaluation of RRS. METHODS: We conducted an international consensus process. Participants included patients, carers, clinicians, research scientists, and members of the International Society for Rapid Response Systems with representatives from Europe, Australia, Africa, Asia and the US. Scoping reviews of the literature identified potential metrics. We used a modified Delphi methodology to arrive at a list of candidate indicators that were reviewed for feasibility and applicability across a broad range of healthcare systems including low and middle-income countries. The writing group refined recommendations and further characterized measurement tools. RESULTS: Consensus emerged that core outcomes for reporting for quality improvement should include ten metrics related to structure, process and outcome for RRS with outcomes following the domains of the quadruple aim. The conference recommended that hospitals should collect data on cardiac arrests and their potential predictability, timeliness of escalation, critical care interventions and presence of written treatment goals for patients remaining on general wards. Unit level reporting should include the presence of patient activated rapid response and metrics of organizational culture. We suggest two exploratory cost metrics to underpin urgently needed research in this area. CONCLUSION: A consensus process was used to develop ten metrics for better understanding the course and care of deteriorating ward patients. Others are proposed for further development.
Authors: Myung Jin Song; Dong-Seon Lee; Yun-Young Choi; Da-Yun Lee; Hye-Min Jo; Sung Yoon Lim; Jong Sun Park; Young-Jae Cho; Ho Il Yoon; Jae Ho Lee; Choon-Taek Lee; Yeon Joo Lee Journal: PLoS One Date: 2022-02-25 Impact factor: 3.240
Authors: Jasmeet Soar; Bernd W Böttiger; Pierre Carli; Keith Couper; Charles D Deakin; Therese Djärv; Carsten Lott; Theresa Olasveengen; Peter Paal; Tommaso Pellis; Gavin D Perkins; Claudio Sandroni; Jerry P Nolan Journal: Notf Rett Med Date: 2021-06-08 Impact factor: 0.826