TY - JOUR
T1 - Failure to rescue—rapid response systems
T2 - A making healthcare safer rapid review
AU - Winters, Bradford D.
AU - Rosen, Michael
AU - Sharma, Ritu
AU - Zhang, Allen
AU - Bass, Eric
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - Background: Rapid response systems (RRSs) were developed to respond to early warnings of unexpected deterioration, but their effectiveness may be limited by factors impacting RRS activation (afferent limb) or response (efferent limb). Despite decades of RRS implementation, patients still experience unrecognized deterioration with associated worse outcomes. Methods: This rapid review used modified search strategies to focus on the most valuable studies performed in the United States. Citations were screened by one reviewer with artificial intelligence as a second reviewer at the title/abstract review stage. The full text of eligible articles was then reviewed by a single team member to confirm eligibility. One reviewer completed the data abstraction, and a second reviewer checked the first reviewer's abstraction. Results: Three categories of interventions were identified: implementation of a new RRS, and modifications to the afferent limb and/or efferent limb of an existing RRS. RRSs may have a large impact in reducing in-hospital mortality and an even greater impact in reducing cardiorespiratory arrest on hospital general wards in adults but the effect is unclear in children. Their impact on unanticipated intensive care unit admission is unclear. Modifications to the afferent and/or efferent limb were associated with a reduction in mortality and the incidence of cardiorespiratory arrest for adults. Conclusions: RRS may have a large beneficial effect on hospital mortality and in-hospital cardiorespiratory arrest, but the strength of the evidence is low due to methodological weaknesses of the studies. Innovations in afferent and efferent limb structures show promise for increased benefit.
AB - Background: Rapid response systems (RRSs) were developed to respond to early warnings of unexpected deterioration, but their effectiveness may be limited by factors impacting RRS activation (afferent limb) or response (efferent limb). Despite decades of RRS implementation, patients still experience unrecognized deterioration with associated worse outcomes. Methods: This rapid review used modified search strategies to focus on the most valuable studies performed in the United States. Citations were screened by one reviewer with artificial intelligence as a second reviewer at the title/abstract review stage. The full text of eligible articles was then reviewed by a single team member to confirm eligibility. One reviewer completed the data abstraction, and a second reviewer checked the first reviewer's abstraction. Results: Three categories of interventions were identified: implementation of a new RRS, and modifications to the afferent limb and/or efferent limb of an existing RRS. RRSs may have a large impact in reducing in-hospital mortality and an even greater impact in reducing cardiorespiratory arrest on hospital general wards in adults but the effect is unclear in children. Their impact on unanticipated intensive care unit admission is unclear. Modifications to the afferent and/or efferent limb were associated with a reduction in mortality and the incidence of cardiorespiratory arrest for adults. Conclusions: RRS may have a large beneficial effect on hospital mortality and in-hospital cardiorespiratory arrest, but the strength of the evidence is low due to methodological weaknesses of the studies. Innovations in afferent and efferent limb structures show promise for increased benefit.
KW - clinical deterioration
KW - failure to rescue
KW - Rapid response systems
UR - http://www.scopus.com/inward/record.url?scp=85210963829&partnerID=8YFLogxK
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U2 - 10.1177/25160435241298992
DO - 10.1177/25160435241298992
M3 - Article
AN - SCOPUS:85210963829
SN - 2516-0435
JO - Journal of Patient Safety and Risk Management
JF - Journal of Patient Safety and Risk Management
ER -