Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)

developmentThe natural progression of chronic disease involves periods of apparent remission interspersed by exacerbations and, in the year leading to death, multiple hospitalisations. Some indicators of poor prognosis can suggest a patient is nearing the end of life, and have been found useful for initiating discussions with families regarding pre-emptive care planning.1 Yet there is uncertainty of the time, frequency and duration of the next episode of decompensation as well as the ultimate prognosis causing doubts about whether to continue active management. Further, while the majority of people want to die at home, most will die in hospital.

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Rapid response systems

rapid response systems

  • Rapid response systems (RRSs) are one of the first organisation-wide, patient-focused systems to be developed to prevent potentially avoidable deaths and serious adverse events such as cardiac arrests.
  • RRSs identify seriously ill and at-risk patients and those whose condition is deteriorating, using abnormal vital signs and observations that trigger an urgent response by staff who are able to deal with any medical emergency.
  • RRS teams also respond to staff concern — any bedside nurse or doctor who is concerned about his or her patient can seek assistance.
  • RRSs require the support of the whole hospital. This includes resources, educational programs and agreed ways of evaluating RRS effectiveness.
  • RRSs may reduce deaths

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Rapid-Response Teams

rapid response teamsRapid-response teams have been introduced to intervene in the care of patients with unexpected clinical deterioration. These teams are key components of rapid-response systems, which have been put in place because of evidence of “failure to rescue” with available clinical services, leading to serious adverse events. A serious adverse event may be defined as an unintended injury that is due in part to delayed or incorrect medical management and that exposes the patient to an increased risk of death and results in measurable disability. Rapidresponse systems aim to improve the safety of hospital-ward patients whose condition is deteriorating. These systems are based on identification of patients at risk, early notification of an identified set of responders, rapid intervention by the response team, and ongoing evaluation of the system’s performance and hospital-wide processes of care. Rapid-response systems have been implemented in many countries and across the United States.

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Resuscitation and rapidresponsesystems

resuscitation rapidresponsesystemsJust over 50 years ago, Peter Safar and colleagues began work on preventing mortality from cardiac arrest using a combination of rescue breathing and chest compressions, now known as cardiorespiratory resuscitation (CPR).

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What is new with rapid response systems?

whats new rapid response systems

The term rapid response system (RRS) describes a hospital- wide approach to (a) improve the detection of deteriorating patients and (b) provide a responding team who commence treatment aimed at preventing serious adverse events including cardiac arrest and unexpected death. Ward staff are alerted to clinical deterioration when patients fulfil predefined criteria based on vital sign derangement and other important changes in the patient’s clinical status. Rapid response team (RRT) staff have the required skills and knowledge to assess and manage critically ill patients. As such, they are often based in the intensive care unit (ICU). An essential underlying tenant of the RRS model is that early intervention in the course of deterioration improves patient outcome.

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