Background
The Rapid Response System (RRS) is a globally recognised hospital safety service that recognises and
escalates inpatient clinical deterioration for management by a Rapid Response Team (RRT).
Successful use of Non-Technical Skills (NTS) during RRT calls may facilitate and expedite resolution of
clinical deteriorations.
Improving clinicians’ use of NTS typically involves dedicated training which requires considerable
time and financial resources, which are commonly not available. Therefore, this research was
undertaken, aiming to promote use of NTS during RRT calls using a pragmatic approach with minimal
resource requirements.
Methods
This research, presented herein as a PhD-by-publication, investigated the re-design of an existing RRS
on the use of NTS during RRT calls. The re-design had three components: 1) shift-by-shift meetings of
the RRT; 2) RRT role badges; and 3) a structured “hand-off” transition-of-care process at the end of
calls.
A literature review was undertaken on NTS in context of an RRS to inform development of the redesign.
Prior to implementation of the re-design (Phase 1), RRT Members and Users (ward staff that
called the RRT) were surveyed regarding their experiences of RRT calls, and analysis of an RRS
performance indicator: repeat RRT calls to the same patient during an admission, was conducted.
Following introduction of the RRS re-design (Phase 2), the survey of RRT Members and Users was
repeated, and an interrupted time series analysis was performed to determine the effect of the redesign
on the proportion of RRT attended patients going on to have repeat calls.
Results
Potentially preventable repeat calls (i.e. following an initial call that ended despite an ongoing breach
of RRT calling triggers) were associated with increased risk of in-hospital mortality (odds ratio 4.80
[95% confidence interval (CI) 2.96 – 7.81)], by comparison to not having repeat RRT calls.
The RRS re-design was associated with improvements in both RRT Members’ and Users’ perceptions
of NTS use during RRT calls. There were significant reductions in the proportion of RRT Members and
Users reporting inter-personnel conflicts during calls following introduction of the re-design (26% less
[95%CI -41% – -11%] and 14% less [95%CI -21% – -7%], respectively).
However, there was little evidence of a significant difference in the proportion of RRT-attended
patients (per month) going on to have repeat calls (6% fewer [95%CI -15.1% – 3.1%]) or in the mean
number of calls per admission for these patients (-0.07 calls [95%CI -0.23 – 0.08]).
Conclusions
This program of research showed that a pragmatic NTS-based re-design of an existing RRS was
associated with statistically significant reductions in RRT Members’ and Users’ perceptions of
conflicts during RRT calls; however, this did not extend to a significant reduction in repeat RRT calls.
Conflict between staff can exacerbate and/or be symptomatic of burnout. The results suggest that
the RRS re-design had some beneficial effects on the working relationship between RRT Members
and Users, which is promising as the well-being and resilience of clinicians is vital for sustainability of
effective healthcare delivery. This research provides an important precedent for other resource-limited hospitals by demonstrating
that a low-cost quality improvement initiative could be implemented for an existing RRS. The RRS redesign
has broad applicability, and potential for future iterative refinement.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 202
