What is it about?
The activity of Rapid Response Systems (RRSs) relies on the afferent and the efferent limbs, including clinicians, and the administrative and the quality improvement limbs, including managers and administrators. The afferent limb includes ward physicians and nurses to identify at-risk patients and to trigger a response by emergency teams. The activity of ward clinicians encloses different steps, such as monitoring, recognition, and escalation of care to deteriorating patients. Different factors may influence these steps leading to suboptimal care of patients, delayed or failed activation of RRS teams, and increased risks of worsening outcomes.
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Why is it important?
Facilitators and barriers may affect the performance of the afferent limb, reducing the treatment of patient deterioration on general wards. The monitoring process is influenced by the lack of recording, poor documentation of respiratory rate, and the influence of different facilitators and barriers. The recognition process is affected by poor compliance with calling criteria and the impact of communication. The escalating process enclosed the influence of cultural barriers and personal judgment, delayed team calls, and the effects of delays on clinical outcomes. Mainly, delayed team calls were 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.
Perspectives
The RRSs exhibit important differences across different countries because of the complexity of the intervention, the variability of calling criteria, the team composition, and the clinical expertise of clinicians. To date, this hospital-wide system remains the best choice to improve clinical management of deteriorating patients in general wards. Regardless, evidence documents the effectiveness of this approach in reducing cardiac arrest and in-hospital mortality. However, several factors may affect the performance of the afferent limb of RRSs. The research efforts need to be focused on the clinical governance of limiting factors to ensure proper management of hospitalized patients showing physiological derangements.
Professor (Adjunct) Marcello Difonzo
Degree in Nursing, School of Medicine, University of Bari Aldo Moro, Bari, Italy. Di Venere teaching hospital, Bari, Italy
Read the Original
This page is a summary of: Performance of the Afferent Limb of Rapid Response Systems in Managing Deteriorating Patients: A Systematic Review, Critical Care Research and Practice, October 2019, Hindawi Publishing Corporation,
DOI: 10.1155/2019/6902420.
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