Evaluating A Rapid Response Team Performance To Implement Best Practice in Rapid Response Team Protocol

Background Rapid Response Teams (RRT) provide clinical resources to improve patient safety outcomes at healthcare institutions. This team promptly responds to deteriorating patient conditions to prevent further deterioration and reduce mortality rates. Rapid response teams do not always perform optimally. Reasons for this performance failure include breakdowns in communication, team dynamics, or other variables that can often be adjusted when the team members understand the role these variables play in undermining the performance of the RRT. An understanding of the perceptions of the RRT members regarding their roles and potential areas of improvement did provide valuable data that was utilized to improve the efficiency and effectiveness of the RRT. Purpose The purpose of this project was to create an evidence-based protocol for best practices in RRT responses by evaluating the perceptions of the rapid response team members regarding RRT performance at a medical center in Michigan. Current RRT practices were compared to the evidence-based standards of care that influenced recommendations for improvement based on the gaps identified. -- Method. This project utilized a qualitative approach with the use of semi-structured guided interviews held via Zoom to gather data related to the experiences of RRT members, to gain an in-depth understanding on the issues concerning the performances of the RRT. Seventeen participants who met the research criteria were selected. Participants who consented to be interviewed were scheduled in chronological order in which they gave consent. Participants were recruited via hospital unit huddles and one on one encounters, based on the project inclusion criteria, and were then scheduled for individual interviews that were audio-recorded, transcribed, and analyzed for thematic contents. This project was guided by Kurt Lewin\u27s Change Theory, which is a change model geared at preparing team members to become change agents. Applying this model will ensure that team members will be equipped to implement the quality improvement changes in the rapid response system. Associates will be provided with the necessary strategies to unlearn the ineffective old ways of clinical practices and embrace the new evidenced based practice guidelines. Results Data analysis revealed major themes that have been affecting the performances of the RRT. They were ineffective team dynamics, activation barriers, inadequate competency training/skills validation, staffing challenges, and failure to debrief after RRT encounters. Other issues emerged during this study that were important issues affecting the performances of the RRT. They were delayed response time of RT, attitudes of providers, and unavailability of attending physicians. Conclusion Ineffective team dynamics, poorly defined roles, crowd control issues, and inadequate education and training were the most critical factors interfering with the efficiency of the RRT. A change in policy that has the potential to optimize the performance of the RRT was developed in accordance with the best practice guidelines. The rapid response team is an important player in early recognition of declining patient conditions outside of intensive care areas. There is documented evidence of what excellent rapid response teams need to maintain their efficient performance. Teams may not always function at the optimum levels they desire. The qualitative interview results derived from experienced rapid response team members was compared with evidence based standards of practice. Improvements and recommendations were developed and shared with the management team at the project site

The Victorian Newsletter (Fall 1959)

The Victorian Newsletter is edited for the English X Group of the Modern Language Association by William E. Buckler, 737 East Building, New York University, New York 3, New York.Some pages are missing from this record

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit