Rapid Response System (RRS) - jsem.me

1 1 Rapid Response System (RRS) RRS RRS Early Warning Scoring System (EWSS) RRS 4 2 How to cite this material: 5 Million Lives Campaign. Getting Started Kit: Rapid Response Teams. Cambridge, MA: Institute for Healthcare Improvement; 2008. (Available at ) 3 Rapid Response System 2005 6 the International Conference on Medical Emergency Team ( International Conference on Medical Emergency Team: ICMT ) MET 4 Rapid Response System Devita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006 Sep;34(9):2463-2478.

2 RRS 2005 6 ICMET Medical Emergency Team (MET) : Rapid Response Team (RRT) : MET Critical Care Outreach (CCO) Team : ICU ICU 4 M E T, RRT Rapid Response System (RRS) RRS Early Warning Scoring System (EWSS) EWSS 2 EWSS 5 70 45/64 8 Schein RM, Hazday N, Pena M, et al.

3 Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98:1388-1392. 66 (99/150) 6 25 (25/99) Franklin C, Mathew J. Developing strategies to prevent in hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med. 1994;22(2):244-247. 6 51 17 Buist M, Bernard S, Nguyen TV, Moore G, Anderson J. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004;62(2):137-141. Franklin 6 <70,>130mmHg <45,>125 per minute <10,>30 per minute Franklin C, Mathew J. Developing strategies to prevent in hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event.

4 Crit Care Med. 1994;22(2):244-247 6 RRS ICU 50 Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324:387-390. ICU 58 37 Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32:916-921. ICU (4% vs. 30%) Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A. The patient-at-risk team: identifying and managing seriously ill ward patients. Anesthesia. 1999;54(9):853-860. 100 /1000 - ( 1,000 ) Sharek PJ, Layla M, Parast LM, et al.

5 Effect of a Rapid Response team on hospital-wide mortality and code rates outside the ICU in a children s hospital. JAMA. 2007;298(19):2267-2274. 17 1,000 DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf health care. 2004;13(4):251-254. 7 Early Warning Scoring System (EWSS) (EWSS) ICU EWSS Goldhill DR, McNarry AF, Mandersloot G and McGinley A. A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia. 2005 Jun;60(6):547-55 Barking, Havering & Redbridge University Hospitals NHS Trust 101 200 9 20 51 110 90 1mL/kg/2 RRT 2 30 8 RRS 4 Afferent limb Efferent limb Evaluate or Process Improvement limb ( )

6 Administrative limb Afferent limb RRS EWSS Efferent limb RRS MET,RRT ICU MET,RRT 3 closed loop communication Evaluate or Process Improvement limb ( ) RRS RRS Administrative limb RRS RRS RRS 9 RRS M E T, RRT M E T, RRT M E T, RRT RRS RRS MET.

7 RRT ICU ICU ICU ICU ICU 4 M E T, RRT M E T, RRT M E T, RRT 10 ICU MET, RRT M E T, RRT RRS 8 36 5 SpO2 85 40 130 160 90 200 50ml/4hr 10 HCU 30 M E T, RRT 11 MET.

8 RRT PHS M E T, RRT ACLS M E T, RRT SBAR M E T, RRT SBAR M E T, RRT RRS 3 1,000 ICU RRT 12 RRT 13 IHI 3 Plan-Do-Study-Act (PDSA) cycle PDSA 14 RRS Tips.

9 MET, RRT ME T,RRT MET,RRT MET,RRT MET,RRT MET,RRT ACLS 15 Tips: MET,RRT Failure-to-rescue MET,RRT MET,RRT MET,RRT