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52 S C O P E O F C R I T I C A L C A R E

TABLE 3.10 Examples of recent rapid response system research

Study Design Sample Outcome measures Findings
Bristow et al. 2000. Cohort comparison 1510 adverse events Casemix-adjusted rates No significant differences in cardiac arrests
Australia 145 in 3 hospitals (1 MET, of cardiac arrest, (control = 5.1/1000 admissions; MET =
2 control) death, unplanned 3.8) or deaths (18.4 & 15.1 vs 13.3); fewer
ICU readmissions unanticipated ICU readmissions (11.2 &
12/1000 admissions vs 6.4)
Buist et al. 2002. Prospective 19,317 (1996); 22,847 Incidence and outcome 50% reduction in cardiac arrests (before =
Australia 139 before–after (1999) of unexpected 3.8/1000 admissions; MET = 2.1);
cardiac arrest mortality 77% vs 55%
Bellomo et al. 2003. Prospective, All admissions: 21,090 Cardiac arrests, deaths 65% reduction in cardiac arrests (63 vs 22);
Australia 137 controlled (1999); 20,921 57% reduction in deaths from cardiac
before–after (2000–01) to 1 arrest (37 vs 16)
hospital
Bellomo et al. 2004. Prospective, Major surgery (before Adverse events, death, Decrease in adverse outcomes (before =
Australia 146 controlled n = 1116; MET n = hospital length of 301/1000 surgical admissions; MET =
before–after 1067) stay 127); 37% decrease in postoperative
deaths; decreased hospital stay (24 days
vs 20 days)
DeVita et al. 2004. Retrospective, 4489 arrest/MET calls Crisis calls, cardiac Increase in crisis team usage (before =
USA 131 before–after in 1 hospital arrests 14/1000 admissions; MET = 26); 17%
decrease in cardiac arrests (before = 6.5;
MET = 5.4); no change in deaths from
arrests
Hillman et al. 2005. Cluster-randomised 23 hospitals (12 Composite outcome: Similar incidence for composite (control =
Australia 144 controlled trial intervention; 11 cardiac arrest, 7.1/1000 admissions; MET = 6.6) and
control) unexpected death, individual outcomes; calls not associated
unplanned ICU with an event (control = 37%; MET =
readmission 70%); inadequate monitoring and
documentation of unstable patients
noted
Dacey et al. 2007. Prospective All adult admissions to Cardiac arrest, Average cardiac arrests per 1000
USA 147 before–after 1 hospital over 5 unplanned ICU discharges per month decreased from
months admissions, hospital 7.6 before to 3.0 after implementing the
mortality rapid response team; unplanned ICU
admissions decreased from 45% to 29%;
hospital mortality decreased from 2.82%
to 2.35%

LN is described as one of education of both staff and SUMMARY
patients, supervision, follow-up of patients discharged
from ICU, liaison and coordination with ward In summary, this chapter has provided an overview of
staff, assessment, assistance in development and coor- safety and quality in critical care. Evidence-based nursing
dination of the discharge plan, preparation of written is viewed as an important foundation to promote quality
documentation and referral. 143 Despite the broadly as is the development and use of good quality clinical
defined nature of this role, one of its primary practice guidelines. Quality and safety monitoring under-
aspects involves supporting other staff, both within pin understanding the risks that patients face in critical
and beyond the ICU, in providing continuity of care care. The use of care bundles, checklists and information
for ICU patients. 143 The scope of practice, qualifica- and communication technologies may improve quality of
tions and job titles of LNs have yet to be standardised, care. Techniques such as the analysis of clinical incidents,
although a LN Special Interest Group now exists root cause analyses and failure mode and effects analysis
under the auspices of the Australian College of Critical help in understanding situations that place patients at risk
Care Nurses. This group is working to develop a standard of adverse events. One particular high risk scenario is the
role description and core competencies for the LN deteriorating patient, with a number of rapid response
role. Interestingly, while the literature about LNs is pre- systems now being implemented to respond to this sce-
dominantly from Australia and New Zealand, the service nario. Understanding situations that place patients at risk
is now emerging in countries such as Canada and of harm as well as the safety culture of a unit or organisa-
Scotland. tion provide the foundation to improve safety culture.