What is it about?
The in-hospital emergency describes a system designed to ensure an adequate response to cardiac arrests, and other medical emergencies, avoiding sudden patient deterioration. To ensure these emergencies the Rapid Response System (RRS) has been proposed to ensure these emergencies. The afferent limb of the RRS, which includes doctors and nurses of general wards, aims to identify the patient in crisis, at risk of physiological deterioration, and enables an appropriate response. The efferent limb indicates the emergency teams of clinicians with expertise in critical care. The RRS is named in different ways according to the countries and the compositions of the emergency teams. The Medical Emergency Team (MET) is diffused in Australia, the Rapid Response Team (RRT) in the United States of America, the Critical Care Outreach Service (CCOS) in the United Kingdom, and the Critical Care Response Team (CCRT) in Canada.
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Why is it important?
In general wards, the physiological instability of a patient needs increased monitoring of vital signs with the intensification of clinical interventions and treatments to reach a clinical balance. Differently, patients whose conditions remain unstable need the intervention of the efferent limb to avoid further clinical deterioration. To facilitate the early detection of deteriorating patients, various Track and Trigger Systems (TTSs) have been developed. The tracking indicates the evaluation of physiologic signs to recognize at-risk patients, such as objective criteria, subjective criterion (worried criterion), or assigning weighted scores to physiological values with the calculation of a total score. The triggering indicates the predefined criteria for activating the emergency teams. These criteria may be one extreme value of the objective criteria or the subjective criterion, two or more extreme values of the objective criteria or the threshold of the total score (low, medium, or high score) previously established.
Perspectives
The topic of this paper focuses on an essential question, namely how the afferent limb of the RRS works. Early treatment of clinical instability of patients in hospital general wards reduces the incidence of serious adverse events such as unexpected cardiac arrest, unplanned intensive care admissions, and unexpected death. The fundamental steps to avoid delayed responses are monitoring, recognition of patient deterioration, and early treatment of adverse events, with activation of the emergency teams of RRSs. Hence, the ward staffs play a key role to ensure the proper treatment of physiological deterioration, improving clinical outcomes.
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: In-hospital emergency: how to identify the patient in crisis, Clinical Management Issues, September 2015, Seed SRL,
DOI: 10.7175/cmi.v9i3.1185.
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