Volume 202 - Issue 10
Rapid response systems
Author: Michael D Buist
Med J Aust 2015; 202 (10): 523. || doi: 10.5694/mja14.01601
Published online: 1 June 2015
Published online: 1 June 2015
Overdependence on rapid response systems has not improved patient safety in hospitals
To the Editor: Hillman and colleagues give an excellent overview of rapid response systems (RRSs).1 There is no doubt that this system of care that matches “the right people — with the right skills and knowledge — with the right patients at the right time” is a vast improvement on the usual traditional hierarchical referral model of care, particularly for patients in acute care hospitals whose condition is deteriorating.
However, the authors have not discussed our now overdependence on such systems2 and that, despite this, overall patient safety has not improved in our hospitals.3-5 Perhaps there is another side to the RRS story. Having been involved with the RRS journey from the beginning,6 I am concerned that what we now see on our wards with patients with deteriorating conditions is a syndrome of learned helplessness that is underwritten by the presence of the RRS. Leading on from this, if the RRS is not appropriately activated, for whatever reason, the patients with deteriorating conditions often get no care, as the ward staff now have no cognisance of how to give basic first aid to such patients.7 There is now the palpable sense in the general wards that we do not need to worry about these patients at all, as all we need to do is activate the RRS. The concept of basic clinical patient care at the bedside has been lost.
Rather than the research agenda that is proposed by Hillman et al, we might need to gain a better understanding of why we need RRSs at all? Also, what is it that we are, or are not, teaching our students and junior doctors that makes them so dependent on this system of care? While undoubtedly there are RRS calls that require sophisticated resuscitation skills, the vast majority of calls are for simple interventions that can easily be carried out in the ward setting, or even no interventions.
Of particular concern, the authors claim that “It has been established that ICUs and RRSs identify and treat patients with a similar level of mortality risk”. In making this claim, the only reference cited is work undertaken by myself and colleagues that makes no such claim at all.8 The quoted reference is quite simply, as the title explains, an “Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study”.
Competing interests
I am the founder and a shareholder of Patientrack.
References
- Hillman KM, Chen J, Jones D. Rapid response systems. Med J Aust 2014; 201: 519-521. 1
- Chen J, Ou l, Hillman KM, et al. Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion. Med J Aust 2014; 201: 167-170. 2
- Landrigan CP, Parry GJ, Bones CB, et al. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2010; 363: 2124-2134. 3
- Classen DC, Resar R, Griffin F, et al. ‘Global trigger tool' shows that adverse events in hospitals may be ten times greater than previously measured. Health AFF (Millwood) 2011; 30: 581-589. 4
- Baines RJ, Langelaan M, de Bruijne MC, et al. Changes in adverse events in hospitals over time: a longitudinal retrospective patient record review study. BMJ Qual Saf 2013; 22: 290-298. 5
- Buist MD, Moore GE, Bernard SA, et al. Effects of the medical emergency team on the reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 2002; 324: 387-390. 6
- Shearer B, Marshall S, Buist MD, et al. What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service. BMJ Qual Saf 2012; 21: 569-575. lefthere
- Buist M, Bernard S, Nguyen TV, et al. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation 2004; 62: 137-141. 8