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"Identifying the hospitalised patient in crisis"-A consensus conference on the afferent limb of Rapid Response Systems

DeVita, Michael A.; Smith, Gary B.; Adam, Sheila K.; Adams-Pizarro, Inga; Buist, Michael; Bellomo, Rinaldo; Bonello, Robert; Cerchiari, Erga; Farlow, Barbara and Goldsmith, Donna, et al. (2010) In Resuscitation 81(4). p.375-382
Abstract
Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring. Methods: A consensus conference of international experts in safety, RRS, healthcare technology, education, and risk prediction was convened to review current knowledge and opinion on clinical monitoring. Using established consensus procedures, four topic areas were addressed: (1) To what extent do physiologic abnormalities predict risk for patient deterioration? (2) Do... (More)
Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring. Methods: A consensus conference of international experts in safety, RRS, healthcare technology, education, and risk prediction was convened to review current knowledge and opinion on clinical monitoring. Using established consensus procedures, four topic areas were addressed: (1) To what extent do physiologic abnormalities predict risk for patient deterioration? (2) Do workload changes and their potential stresses on the healthcare environment increase patient risk in a predictable manner? (3) What are the characteristics of an "ideal" monitoring system, and to what extent does currently available technology meet this need? and (4) How can monitoring be categorized to facilitate comparing systems? The major findings include: (1) vital sign aberrations predict risk, (2) monitoring patients more effectively may improve outcome, although some risk is random, (3) the workload implications of monitoring on the clinical workforce have not been explored, but are amenable to study and should be investigated, (4) the characteristics of an ideal monitoring system are identifiable, and it is possible to categorize monitoring modalities. It may also be possible to describe monitoring levels, and a system is proposed. (C) 2010 Elsevier Ireland Ltd. All rights reserved. (Less)
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@article{1c2de479-5a19-404c-897b-f4b4d8e04c41,
  abstract     = {Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring. Methods: A consensus conference of international experts in safety, RRS, healthcare technology, education, and risk prediction was convened to review current knowledge and opinion on clinical monitoring. Using established consensus procedures, four topic areas were addressed: (1) To what extent do physiologic abnormalities predict risk for patient deterioration? (2) Do workload changes and their potential stresses on the healthcare environment increase patient risk in a predictable manner? (3) What are the characteristics of an "ideal" monitoring system, and to what extent does currently available technology meet this need? and (4) How can monitoring be categorized to facilitate comparing systems? The major findings include: (1) vital sign aberrations predict risk, (2) monitoring patients more effectively may improve outcome, although some risk is random, (3) the workload implications of monitoring on the clinical workforce have not been explored, but are amenable to study and should be investigated, (4) the characteristics of an ideal monitoring system are identifiable, and it is possible to categorize monitoring modalities. It may also be possible to describe monitoring levels, and a system is proposed. (C) 2010 Elsevier Ireland Ltd. All rights reserved.},
  author       = {DeVita, Michael A. and Smith, Gary B. and Adam, Sheila K. and Adams-Pizarro, Inga and Buist, Michael and Bellomo, Rinaldo and Bonello, Robert and Cerchiari, Erga and Farlow, Barbara and Goldsmith, Donna and Haskell, Helen and Hillman, Kenneth and Howell, Michael and Hravnak, Marilyn and Hunt, Elizabeth A. and Hvarfner, Andreas and Kellett, John and Lighthall, Geoffrey K. and Lippert, Anne and Lippert, Freddy K. and Mahroof, Razeen and Myers, Jennifer S. and Rosen, Mark and Reynolds, Stuart and Rotondi, Armando and Rubulotta, Francesca and Winters, Bradford},
  issn         = {1873-1570},
  keyword      = {Critical care outreach,Rapid response team,Medical emergency team,Vital signs,Rapid response system,Monitoring,Cardiac arrest,Resuscitation,Patient safety,Risk},
  language     = {eng},
  number       = {4},
  pages        = {375--382},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {"Identifying the hospitalised patient in crisis"-A consensus conference on the afferent limb of Rapid Response Systems},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2009.12.008},
  volume       = {81},
  year         = {2010},
}