Skip to main content
SpringerLink
Log in

Making the Business Case for a Rapid Response System

  • Chapter
  • First Online:
Textbook of Rapid Response Systems

  • 1736 Accesses

Abstract

Compared with adult-focused systems, paediatric rapid response systems face slightly different challenges. Detecting early signs of clinical deterioration is more challenging given the widely varying normal ranges of vital signs in children from infancy to late adolescence. In addition, cardiac arrest and death are far less common in hospitalized children than in adults, which is a good thing, but makes identifying meaningful outcome metrics of rapid response system performance more complicated. In this chapter, we describe the distinguishing features of paediatric rapid response systems, with a special focus on the recognition of clinical deterioration on general inpatient units and selection of outcomes following rapid response system implementation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Osterwalder A, Pigneur Y. Business model generation. A handbook for visionaries, game changers, and challengers. Hoboken: John Wiley & Sons, Inc.; 2010.

    Google Scholar 

  2. Orphanidou C, Clifton D, Khan S, Smith M, Feldmar J, Tarassenko L. Telemetry-based vital sign monitoring for ambulatory hospital patients. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:4650–3. Annual International Conference of the IEEE

    PubMed  Google Scholar 

  3. Smith GB, Prytherch DR, Schmidt P, Featherstone PI, Knight D, Clements G, Mohammed MA. Hospital-wide physiological surveillance – a new approach to the early identification and management of the sick patient. Resuscitation. 2006;71:19–28.

    Article  PubMed  Google Scholar 

  4. Tarassenko L, Hann A, Young D. Integrated monitoring and analysis for early warning of patient deterioration. Br J Anaesth. 2006;97:64–8.

    Article  CAS  PubMed  Google Scholar 

  5. Independent Hospital Pricing Authority. Activity based funding, [cited 2015 July 31] Available from: http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/content/funding.

  6. Centers for medicare & medicaid services. Bundled payments for care improvement (BPCI) initiative: general information|center for medicare & medicaid innovation. [cited 2013 December 19] Available from: http://innovation.cms.gov/initiatives/bundled-payments/.

  7. Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standards. Sydney: ACSQHC; 2011.

    Google Scholar 

  8. Australian Commission on Safety and Quality in Health Care. National consensus statement: essential elements for recognising and responding to clinical deterioration. Sydney: ACSQHC; 2010.

    Google Scholar 

  9. Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA. 2006;295:324–7.

    Article  CAS  PubMed  Google Scholar 

  10. How-to guide: deploy rapid response teams. Institute for Healthcare Improvement. Cambridge, Massachusetts, USA. 2012. [cited 2015 August 26] Available from: http://www.ihi.org/resources/Pages/Tools/HowtoGuideDeployRapidResponseTeams.aspx.

  11. DeVita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34(9):2463–78.

    Article  PubMed  Google Scholar 

  12. Santamaria J. Crises and accountability, RRT from the director. Proceedings of the ANZICS Safety & Quality Conference: the role of intensive care with Rapid Response Teams. 2014; Melbourne, Australia

    Google Scholar 

  13. McGrath RB. In-house cardiopulmonary resuscitation – after a quarter of a century. Ann Emerg Med. 1987;16:1365–8.

    Article  CAS  PubMed  Google Scholar 

  14. Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008;299:785–92.

    Article  CAS  PubMed  Google Scholar 

  15. Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams. A systematic review and meta-analysis. Arch Intern Med. 2010;170(1):18–26.

    Article  PubMed  Google Scholar 

  16. Tobin A, Santamaria J. Medical emergency teams are associated with reduced mortality across a major metropolitan health network after two years’ service: a retrospective study using government administrative data. Crit Care. 2012;16:R210.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Smith C, Perkins G, Bullock I, Bion J. Undergraduate training in the care of the acutely ill patient: a literature review. Intensive Care Med. 2007;33:901–7.

    Article  PubMed  Google Scholar 

  18. Hillman K. How to do post-hoc response reviews. 6th International symposium on rapid response systems and medical emergency teams. Pittsburgh, USA, 11, 12th May 2010.

    Google Scholar 

  19. Westbrook JI, Ling L, Lehnbom EC, Baysari MT, Braithwaite J, Burke R, Conn C, Day RO. What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International J Qual Health Care. 2015;27:1–9.

    Article  Google Scholar 

  20. Russ AL, Fairbanks RJ, Karsh BT, Militello LG, Saleem JJ, Wears RL. The science of human factors: separating fact from fiction. BMJ Quality and Safety. doi: 10.1136/bmjqs-2012-001450

  21. Subbe CP, Welch JR. Failure to rescue: using rapid response systems to improve care of the deteriorating patient in hospital. Clinical Risk. 2013;19:6–11.

    Article  Google Scholar 

  22. Cuthbertson BH, Sith GB. A warning on early-warning scores! Br J Anaesth. 2007;98:704–6.

    Article  CAS  PubMed  Google Scholar 

  23. Chalwin R, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J. 2013;43(9):962–9.

    Article  CAS  PubMed  Google Scholar 

  24. Helmreich RL, Merritt AC, Wilhelm JA. The evolution of crew resource management training in commercial aviation. Int J Aviat Psychol. 1999;9:19–32.

    Article  CAS  PubMed  Google Scholar 

  25. Gillon S, Radford S, Chalwin R, DeVita M, Endacott R, Jones D. Crisis resource management, simulation training and the medical emergency team. Crit Care Resusc. 2012;14:227–35.

    PubMed  Google Scholar 

  26. Jones D, Hicks P, Currey J, Holmes J, Fennessy GJ, Hillman K, et al. Findings of the first ANZICS conference on the role of intensive care in rapid response teams. Anaesth Intensive Care. 2015;43:369–79.

    CAS  PubMed  Google Scholar 

  27. Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death of critically ill adult patients on general hospital wards (Review) Copyright © 2009 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.

    Google Scholar 

  28. Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, et al. Introducing critical care outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med. 2004;30:1398–404.

    Article  PubMed  Google Scholar 

  29. Gao H, Harrison DA, Parry GJ, Daly K, Subbe CP, Rowan K. The impact of the introduction of CCOS in England: a multicentre interrupted time series analysis. Crit Care. 2007;11:R113.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Harrison D, Gao H, Welch CA, Rowan KM. The effects of critical care outreach services before and after critical care: a matched cohort analysis. J Crit Care. 2010;25:196–204.

    Article  PubMed  Google Scholar 

  31. O’Horo JC, Sevilla Berrios RA, Elmer JL, Velagapudi V, Caples SM, Kashyap R, Jensen JB. The role of the primary care team in the rapid response system. J Crit Care. 2015;30:353–7.

    Article  PubMed  Google Scholar 

  32. Benin AL, Borgstrom CP, Jenq GY, Roumanis SA, Horwitz LI. Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators. BMJ Qual Saf. 2012;21:391–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. The ANZICS-CORE MET. Dose investigators. rapid response team composition, resourcing and calling criteria in Australia. Resuscitation. 2012;83:563–7.

    Article  Google Scholar 

  34. AIHW 2012. Health expenditure Australia 2010-11. Health and welfare expenditure series no. 47. Cat. no. HWE 56. Canberra: AIHW. [cited 2014 August 26] Available from: http://www.aihw.gov.au/publication-detail/?id=10737423009.

  35. AIHW 2014. Australian hospital statistics 2012-13. Health services series no. 54. Cat. no. HSE 145. Canberra: AIHW. [cited 2015 August 26] Available from: http://www.aihw.gov.au/publication-detail/?id=60129546922.

  36. Y Charts. US Health Care Inflation Rate. Bureau of Labor Statistics. [cited 2015 August 21] Available from http://ycharts.com/indicators/us_health_care_inflation_rate

  37. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, et al. A prospective before-and-after trial of a medical emergency team. Med J Aust. 2003;179:283–7.

    PubMed  Google Scholar 

  38. Australian Bureau of Statistics, Wage Price Index Australia March 2015. [cited 2015 August 9] Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/6345.0/.

  39. Nolan JP, Hazinski MF, Billi JE, Boettiger BW, Bossaert L, de Caen AR, et al. Part 1: Executive summary 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2010;81S:e1–e25.

    Article  Google Scholar 

  40. Jones D, Bates S, Warrillow S, Goldsmith D, Kattula A, Way M, et al. Effect of an education program on the utilization of a medical emergency team in a teaching hospital. Intern Med J. 2006;36:231–6.

    Article  CAS  PubMed  Google Scholar 

  41. Jones D, Mitra B, Barbetti J, Choate K, Leong T, Bellomo R. Increasing the use of an existing medical emergency team in a teaching hospital. Anaesth Intensive Care. 2006;34:731–5.

    CAS  PubMed  Google Scholar 

  42. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL, MERIT. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13:251–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Jones DA, Drennan K, Bailey M, Hart GK, Bellomo R, Webb SAR. ANZICS-CORE MET dose investigators. Mortality of rapid response team patients in Australia: a multicentre study. Crit Care Resusc. 2013;15:273–8.

    Google Scholar 

  44. Bassily-Marcus A. Early detection of deteriorating patients: leveraging clinical informatics to improve outcome. Crit Care Med. 2014;42:976–8.

    Article  PubMed  Google Scholar 

  45. Bonafide CP, Localio AR, Song L, Roberts KE, Nadkarni VM, Priestley M, et al. Cost-benefit analysis of a medical emergency team in a children’s hospital. Pediatrics. 2014;134:235–41.

    Article  PubMed  Google Scholar 

  46. Spaulding A, Ohsfeldt R. Rapid response teams and team composition: a cost-effectiveness analysis. Nursing Economics. 2014;32:194–203.

    Google Scholar 

  47. Duncan HP, Frew E. Short-term health system costs of paediatric in-hospital acute life-threatening events including cardiac arrest. Resuscitation. 2009;80:529–34.

    Article  CAS  PubMed  Google Scholar 

  48. Gage H, Kenward G, Hodgetts TJ, Castle N, Ineson N, Shaikh L. Health system costs of in-hospital cardiac arrest. Resuscitation. 2002;54:139–46.

    Article  PubMed  Google Scholar 

  49. Ebell MH, Kruse JA. A proposed model for the cost of cardiopulmonary resuscitation. Med Care. 1994;32:640–9.

    Article  CAS  PubMed  Google Scholar 

  50. Dacey MJ, Mirza ER, Wilcox V, Doherty M, Mello J, Boyer A, Baute R. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med. 2007;35:2076–82.

    Article  PubMed  Google Scholar 

  51. Vrtis MC. Cost/benefit analysis of cardiopulmonary resuscitation: a comprehensive study—Part II. Nurs Manage. 1992;23:44–6. 50-41

    Article  CAS  PubMed  Google Scholar 

  52. Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A. The patient-at-risk team: identifying and managing seriously ill ward patients. Anesthesia. 1999;54:853–60.

    Article  CAS  Google Scholar 

  53. Simmes F, Schoonhoven L, Mintjes J, Adang E, van der Hoeven JG. Financial consequences of the implementation of a rapid response system on a surgical ward. J Eval Clin Pract. 2014;20:342–7.

    Article  PubMed  Google Scholar 

  54. Weinstein MC. How much are americans willing to pay for a quality-adjusted life year? Med Care. 2008;46(4):343–5.

    Article  PubMed  Google Scholar 

  55. Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158:417–25.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care. 2015;19:254. doi: 10.1186/s13054-015-0973-y.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Australian Hospital Statistics 2009-1010. [cited 2015 August 21] Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737419061.

  58. Centers for Disease Control and Prevention. Trends in inpatient hospital deaths: National hospital discharge survey, 2000–2010. NCHS Data Brief 118, March 2013. [cited 2015 August 21] Available from: http://www.cdc.gov/nchs/data/databriefs/db118.pdf.

  59. Crow S, Fischer AC, Schears RM. Extracorporeal life support: utilization, cost, controversy, and ethics of trying to save lives. Semin Cardiothorac Vasc Anesth. 2009;13:183–91.

    Article  PubMed  Google Scholar 

  60. Rana A, Gruessner A, Agopian V, Khalpey Z, Riaz IB, Kaplan B, et al. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150:252–9.

    Article  PubMed  Google Scholar 

  61. Layton A, Robinson T, Tucker IB. Economics for today. 3rd ed. South Melbourne: Cengage Learning; 2009.

    Google Scholar 

  62. Rogers EM. Diffusion of innovations. 5th ed. New York: Simon and Schuster; 2003.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Complex-Wide Adult Intensive Care, Mater Health Services, Raymond Terrace, South Brisbane, QLD, 4101, Australia

    Shane C. Townsend MBBS, FANZCA, FCICM, MBA

Authors
  1. Shane C. Townsend MBBS, FANZCA, FCICM, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shane C. Townsend MBBS, FANZCA, FCICM, MBA .

Editor information

Editors and Affiliations

  1. Department of Surgery, Critical Care, Harlem Hospital Center, New York, New York, USA

    Michael A. DeVita

  2. The Simpson Centre for Health Services Research, South Western Sydney Clinical School, UNSW Sydney, the Ingham Institute for Applied Medical Research and Intensive Care, Liverpool Hospital, Liverpool BC, New South Wales, Australia

    Ken Hillman

  3. Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia

    Rinaldo Bellomo

  4. Royal Berkshire NHS Foundation Trust, Reading, Berkshire, United Kingdom

    Mandy Odell

  5. Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia

    Daryl A. Jones

  6. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Bradford D. Winters

  7. Department of Anesthesia, Stanford University School of Medicine, Palo Alto, California, USA

    Geoffrey K. Lighthall

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Townsend, S.C. (2017). Making the Business Case for a Rapid Response System. In: DeVita, M., et al. Textbook of Rapid Response Systems. Springer, Cham. https://doi.org/10.1007/978-3-319-39391-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-39391-9_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-39389-6

  • Online ISBN: 978-3-319-39391-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation