Can proactive rapid response team rounding improve surveillance and reduce unplanned escalations in care? A controlled before and after study

Abstract

Background: Unplanned escalations manifest as a breakdown of hospital care attributable to clinician error through missed or delayed identification of physiological instability, ineffective treatment, or iatrogenic harm.

Objectives: To examine the impact of an Early Warning Score-based proactive rapid response team model on the frequency of unplanned intra-hospital escalations in care compared with a rapid response team model based on staff nurse identification of vital sign derangements.

Design: Pre- and post Early Warning Score-guided proactive rapid response team model intervention.

Setting: 237-bed community hospital in the southeastern United States.

Participants: All hospitalized adults (n = 12,148) during a pre- and post-intervention period.

Methods: Logistic regressions used to examine the relationship between unplanned ICU transfers and rapid response team models (rapid response team vs. Early Warning Score-guided proactive rapid response team).

Results: Unplanned ICU transfers were 1.4 times more likely to occur during the rapid response team baseline period (OR = 1.392, 95% CI [1.017-1.905]) compared with the Early Warning Score-guided proactive rapid response team intervention period.

Conclusions: This study reports a difference in the frequency of unplanned escalations using different rapid response models, with fewer unplanned ICU transfers occurring during the use of Early Warning Score-guided proactive rapid response team model while accounting for differences in admission volumes, age, gender and comorbidities. Implementation of this model has implications for patient outcomes, hospital operations and costs.

Keywords: Early warning score (EWS); Escalations in care; Nursing; Quality improvement; Rapid response team (RRT); Redesign; Surveillance; Unplanned ICU transfers.