New research in the International Journal of Nursing Studies examines the effect of an Early Warning Score-guided proactive rapid response team model on the frequency of unplanned intra-hospital escalations in care.
Building upon the existing afferent and efferent arms of rapid response systems, Danesh et al, examined the potential efficacy of an Early Warning Score-guided proactive rapid response team rounding approach.
Effective surveillance requires receiving and assessing information in near real-time in order to correctly identify potential clinical deterioration and initiate appropriate intervention in a timely manner. In current practice, rapid response systems are composed of two arms: afferent, which includes computation of Early Warning Scores as part of surveillance, and efferent, which is the deployment of a rapid response team to patients at increased risk for deterioration. Some models now also incorporate a rounding aspect to rapid response teams with the belief that proactive, routine rounding with at-risk patients will allow for a timelier response. The data around proactive rapid response team rounding on patient outcomes varies, however, with single-center reports of both positive and equivocal impact. With this study, Danesh et al, document the first data indicating the positive effect of proactive rounding surveillance guided by automated Early Warning score data on unplanned ICU admissions.
A 237-bed community non-teaching hospital served as the setting for this study, which followed a controlled before and after format. The study followed all inpatient hospitalizations (12,148 cases) during two 6-month periods. Samples were aligned to ensure similar patient age and gender distribution. During the first six-month phase, the rapid response team followed a traditional model of operation where manual activation was required. During the second six-month phase, the Early Warning Score-guided proactive rapid response model was employed.
Study findings demonstrated that the second phase model (labeled Intervention) had a significant effect on unplanned ICU transfers —specifically, a 40% reduction in unplanned ICU admissions. More so, ICU transfers were 1.4 times more likely in the first phase versus the second phase within controlled age, gender, length of stay and comorbidity parameters.
The study authors note that these findings provide “empirical evidence to support a new direction for the evolution of rapid response systems.” The group further assets that the Early Warning Score-guided proactive rapid response team model can be used to reduce afferent arm failures and improve the cognitive and behavioral components of nurse surveillance for hospitalized patients.