Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems.

Clinical Deterioration Critical Care / standards Heart Arrest / therapy Hospital Rapid Response Team Humans Practice Guidelines as Topic Quality Assurance, Health Care / methods
Cardiac arrest Cost Critical care Critical care outreach Medical emergency team Predictable Rapid response

Journal

Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173

Informations de publication

Date de publication:
08 2019
Historique:
received: 24 02 2019
revised: 25 04 2019
accepted: 03 05 2019
pubmed: 28 5 2019
medline: 22 9 2020
entrez: 27 5 2019
Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.resuscitation.2019.05.012 PMID: 31129229
pubmed: 31129229
pii: S0300-9572(19)30180-7
doi: 10.1016/j.resuscitation.2019.05.012
pii:
doi:

Types de publication

Consensus Development Conference Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1-12

Subventions

Organisme : Department of Health
ID : 12/178/18
Pays : United Kingdom

Commentaires et corrections

Type : ErratumIn

Informations de copyright

Copyright © 2019 Elsevier B.V. All rights reserved.

Auteurs

Christian P Subbe (CP)

School of Medical Sciences, Bangor University, Wales, UK. Electronic address: csubbe@hotmail.com.

Jonathan Bannard-Smith (J)

Manchester Royal Infirmary, Manchester, UK.

Jacinda Bunch (J)

The University of Iowa, College of Nursing, USA.

Ratapum Champunot (R)

Buddhachinaraj Phitsanulok Hospital, Phitsanulok, Thailand.

Michael A DeVita (MA)

Harlem Hospital Center, 506 Lenox Avenue, New York, USA.

Lesley Durham (L)

North of England Critical Care Network (NoECCN), North Tyneside General Hospital, North Shields, UK.

Dana P Edelson (DP)

Department of Medicine, University of Chicago, Chicago, IL, US.

Isabel Gonzalez (I)

North of England Critical Care Network (NoECCN), North Tyneside General Hospital, North Shields, UK.

Christopher Hancock (C)

NHS Wales, Innovation House, Bridgend Road, Llanharan CF72 9RP, UK.

Rashan Haniffa (R)

Network for Improving Critical Care Systems and Training, UK.

Jillian Hartin (J)

Patient Emergency Response and Resuscitation Team, UCLH, London, UK.

Helen Haskell (H)

Founder and President of the US Patient Group Mothers Against Medical Error; WHO Patient Safety Champion.

Helen Hogan (H)

London School of Hygiene & Tropical Medicine, London, UK.

Darly A Jones (DA)

Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.

Cor J Kalkman (CJ)

UMC Utrecht, The Netherlands.

Geoffrey K Lighthall (GK)

Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Dr. H3580, Stanford, CA, USA.

James Malycha (J)

Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Level 3, Headley Way, Oxford, UK.

Melody Z Ni (MZ)

Imperial College, London, UK.

Alison V Phillips (AV)

Patient Representative, UK.

Francesca Rubulotta (F)

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.

Ralph K So (RK)

Department of Intensive Care, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, The Netherlands.

John Welch (J)

Consultant Nurse in Critical Care, University College London Hospital, London, UK.

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Classifications MeSH

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questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Arrêt cardiaque › Quality metrics for the evaluation of Rapid...
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