Reduction in omission events after implementing a Rapid Response System: a mortality review in a department of gastrointestinal surgery

BMC Health Services Research

Research

Bjørn S Nedrebø¹  Kristian Strand²  Jan Terje Kvaløy³  Siri Lerstøl Olsen⁴  Britt Sætre Hansen⁵  Eldar Søreide⁶ 

[1] Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway;Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway;Department of Mathematics and Physics, Faculty of Science and Technology, University of Stavanger, Stavanger, Norway;Research Department, Stavanger University Hospital, Stavanger, Norway;Department of Quality and Health Technology, Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 43, 4036, Stavanger, Norway;Department of Emergency Medicine, Stavanger University Hospital, Stavanger, Norway;Department of Quality and Health Technology, Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 43, 4036, Stavanger, Norway;The Research Group for Nursing and Health Care Science, Stavanger University Hospital, Stavanger, Norway;Faculty of Health Sciences, University of Stavanger, Stavanger, Norway;Section for Quality and Patient Safety, Stavanger University Hospital, Stavanger, Norway;

关键词: Rapid Response Systems;    Mortality review;    Health care improvement;    Improvement;    Patient safety;    Adverse events;    Omission events.;   

DOI  :  10.1186/s12913-023-09159-3

 received in 2022-09-12, accepted in 2023-02-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHospitals worldwide have implemented Rapid Response Systems (RRS) to facilitate early recognition and prompt response by trained personnel to deteriorating patients. A key concept of this system is that it should prevent ‘events of omission’, including failure to monitor patients’ vital signs, delayed detection, and treatment of deterioration and delayed transfer to an intensive care unit. Time matters when a patient deteriorates, and several in-hospital challenges may prevent the RRS from functioning adequately. Therefore, we must understand and address barriers for timely and adequate responses in cases of patient deterioration. Thus, this study aimed to investigate whether implementing (2012) and developing (2016) an RRS was associated with an overall temporal improvement and to identify needs for further improvement by studying; patient monitoring, omission event occurrences, documentation of limitation of medical treatment, unexpected death, and in-hospital- and 30-day mortality rates.MethodsWe performed an interprofessional mortality review to study the trajectory of the last hospital stay of patients dying in the study wards in three time periods (P1, P2, P3) from 2010 to 2019. We used non-parametric tests to test for differences between the periods. We also studied overall temporal trends in in-hospital- and 30-day mortality rates.ResultsFewer patients experienced omission events (P1: 40%, P2: 20%, P3: 11%, P = 0.01). The number of documented complete vital sign sets, median (Q1,Q3) P1: 0 (0,0), P2: 2 (1,2), P3: 4 (3,5), P = 0.01) and intensive care consultations in the wards ( P1: 12%, P2: 30%, P3: 33%, P = 0.007) increased. Limitations of medical treatment were documented earlier (median days from admission were P1: 8, P2: 8, P3: 3, P = 0.01). In-hospital and 30-day mortality rates decreased during this decade (rate ratios 0.95 (95% CI: 0.92–0.98) and 0.97 (95% CI: 0.95–0.99)).ConclusionThe RRS implementation and development during the last decade was associated with reduced omission events, earlier documentation of limitation of medical treatments, and a temporal reduction in the in-hospital- and 30-day mortality rates in the study wards. The mortality review is a suitable method to evaluate an RRS and provide a foundation for further improvement.Trial registrationRetrospectively registered.

【 授权许可】

CC BY   
© The Author(s) 2023

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