Modifications to rapid response team (medical emergency team) activation criteria and its impact on patient safety.

BACKGROUND: Modifications to rapid response team (RRT) activation criteria occur commonly in Australian hospitals without evidence to define their use. AIMS: To evaluate the effectiveness of RRT activation criteria modifications in preventing RRT activation and differences in adverse events associated with treatment delays caused by modifications. METHODS: A prospective chart audit of hospital patients with RRT activation criteria modifications admitted during a 12-month period in a large regional hospital in Toowoomba, Australia. The incidence of RRT activation criteria modifications, RRT activations and rates of adverse events following criteria modifications were investigated. Adverse events were defined as a delayed treatment on the ward, unplanned intensive care unit admission, cardiac arrest and unexpected death. Differences in patient outcomes among medical and surgical patients were also investigated. RESULTS: A total of 271 patients out of 4009 admitted patients had modifications to their RRT activation criteria. There was no difference in rates of RRT activation in patients with modified criteria compared with patients with unmodified criteria (P = 0.37). In patients with RRT activation criteria modifications, rates of adverse events were higher in patients who met their modified RRT criteria (93.3%) compared with those who did not meet modified RRT criteria (3.8%; P < 0.001). Additionally, in patients with modifications, rates of adverse events were higher in medical patients (27.6%; n = 50) compared with surgical patients (15.6%; n = 14; P = 0.03). CONCLUSIONS: The results strongly suggest that RRT criteria modification is associated with no difference in rates of RRT activation and with detrimental impacts on patient safety, particularly in medical patients.

Effect of changes in syringe driver height on flow: a small quantitative study.

OBJECTIVE: To quantify flow irregularities in drug delivery caused by vertical displacement of syringe pumps. METHODS: A bench experiment was performed to quantify the effect of height on pumps used in our intensive care and theatre settings. A standard syringe pump and line set loaded with a dye solution was run through a graduated length of tubing, and the effect of changing pump height quantified by measuring progress down the tubing over time. RESULTS: A 30 cm elevation produced significant drug delivery boluses - up to seven times the programmed rate at 2mL/h. Delivery rate increased in inverse proportion to the programmed rate, as did the time taken to return to the programmed rate. Lowering the pump 30 cm resulted in no-flow times of up to 180 seconds at a flow rate of 2mL/h - again inversely proportional to programmed rate. CONCLUSIONS: Vertical displacement of a common syringe pump by 30 cm produced significant bolus and cessation phenomena. These findings confirm the observations of previous authors and also demonstrate significant flow irregularities with smaller vertical displacements than previously tested. Further testing with other brands of pumps is required before a solution to this clinically important problem may be approached.