Adding a Layer of Safety Through Rapid Response Systems

• 1/22/2010
• Author: Steven Berman
• Category: The Journal Blog
• 16041 Views
• 0 Comments
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This week, Michael DeVita, M.D., chief editor of the Journal’s department Rapid Response Systems: The Stories, which began in the July 2006 issue, guests on the blog. Dr DeVita, Professor of both Critical and Internal Medicine in the University of Pittsburgh’s School of Medicine and Executive Vice President of Medical Affairs for West Penn Allegheny Health System, reflects on the state of the art—and science—of rapid response systems. Please feel free to provide your own comments on rapid response systems or to report on your own experience (in the department).

The field of rapid response systems (RRSs) is heating up further. The Joint Commission’s requirement that hospitals have a “process for recognizing and responding as soon as possible” to a patient’s worsening condition (Standard PC.02.01.19) is promoting dissemination. When we started this department, very few journals were accepting manuscripts for publication on the topic. Now, authors are publishing their findings in a wide range of journals, and some major journals have published either original data or meta-analyses. As a result, the field is maturing rapidly, with new applications for response teams, as well as a new recognition of the importance of event detection and prevention. We continue to see that virtually all reported RRSs have all four components of the system: event detection and response triggering (afferent limb), planned event response team (efferent limb), quality analysis, and administrative oversight and maintenance.

Yet RRSs are not without controversy. For example, in a recent article, Chan and colleagues (Archives of Internal Medicine, Jan. 11, 2010) concluded that the data supporting RRSs are not "robust." In a Critical Care Medicine article a year earlier, Chen and colleagues reanalyzed the data from the MERIT trial originally reported in Lancet. They concluded that as the response rate increases, mortality decreases. We expect the debate to continue for some time.

I am optimistic about the increasing impact of RRSs. As I visit various organizations, it is not unusual for me to find a new type of response team or other tweak that improves their RRSs. Hospitals have applied  the RRS principles to find lost or eloped patients, deal with dangerous psychiatric crises, or support the psychological or emotional needs of staff members. The Journal encourages hospitals to report their RRS findings in this department. We accept not only case reports but any research in the field that you seek to disseminate effectively. We hope that as innovators contribute their results to the department, they may be emulated and may have their results tested by others. Only in this way can we learn the true impact of RRSs in promoting patient safety.

There is another way to "be the first on your block" to hear about new methods or resolve problems with your current RRS: attend the only international annual conference in the field. The Sixth Annual International Meeting on Rapid Response Systems will be held in Pittsburgh on May 10–11. As usual, faculty from around the world will be available to present their most recent work, explore controversies, and answer questions. The program is aimed at nurses, physicians, and administrators, as well as both trainees and those who have completed their formal education. For information about abstracts and registration, see http://www.rapidresponsesystem.org .

As the RRS column progresses into its fourth year, we will continue to select stories that provide new insights into how the RRS can add to your clinical care environment and provide an added layer of safety for your patients, their families, and your staff. We hope to hear more from you as you push the boundaries of how the system can be used.