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Making the Business Case for a Rapid Response System

  • Shane C. TownsendEmail author
Chapter

Abstract

Compared with adult-focused systems, paediatric rapid response systems face slightly different challenges. Detecting early signs of clinical deterioration is more challenging given the widely varying normal ranges of vital signs in children from infancy to late adolescence. In addition, cardiac arrest and death are far less common in hospitalized children than in adults, which is a good thing, but makes identifying meaningful outcome metrics of rapid response system performance more complicated. In this chapter, we describe the distinguishing features of paediatric rapid response systems, with a special focus on the recognition of clinical deterioration on general inpatient units and selection of outcomes following rapid response system implementation.

Keywords

Business Plan Canvas Cost Cost-effective Crisis resource management Deflator Diffusion curve Economics Electronic medical record Entrepreneur Executive Financial analysis Governance Learning curve Legal Marketing Model Mortality Non-technical skills Outreach QALY Rapid response team Risk Simulation Standards Telemetry Track and trigger Training Value 

References

  1. 1.
    Osterwalder A, Pigneur Y. Business model generation. A handbook for visionaries, game changers, and challengers. Hoboken: John Wiley & Sons, Inc.; 2010.Google Scholar
  2. 2.
    Orphanidou C, Clifton D, Khan S, Smith M, Feldmar J, Tarassenko L. Telemetry-based vital sign monitoring for ambulatory hospital patients. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:4650–3. Annual International Conference of the IEEEPubMedGoogle Scholar
  3. 3.
    Smith GB, Prytherch DR, Schmidt P, Featherstone PI, Knight D, Clements G, Mohammed MA. Hospital-wide physiological surveillance – a new approach to the early identification and management of the sick patient. Resuscitation. 2006;71:19–28.CrossRefPubMedGoogle Scholar
  4. 4.
    Tarassenko L, Hann A, Young D. Integrated monitoring and analysis for early warning of patient deterioration. Br J Anaesth. 2006;97:64–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Independent Hospital Pricing Authority. Activity based funding, [cited 2015 July 31] Available from: http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/content/funding.
  6. 6.
    Centers for medicare & medicaid services. Bundled payments for care improvement (BPCI) initiative: general information|center for medicare & medicaid innovation. [cited 2013 December 19] Available from: http://innovation.cms.gov/initiatives/bundled-payments/.
  7. 7.
    Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standards. Sydney: ACSQHC; 2011.Google Scholar
  8. 8.
    Australian Commission on Safety and Quality in Health Care. National consensus statement: essential elements for recognising and responding to clinical deterioration. Sydney: ACSQHC; 2010.Google Scholar
  9. 9.
    Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA. 2006;295:324–7.CrossRefPubMedGoogle Scholar
  10. 10.
    How-to guide: deploy rapid response teams. Institute for Healthcare Improvement. Cambridge, Massachusetts, USA. 2012. [cited 2015 August 26] Available from: http://www.ihi.org/resources/Pages/Tools/HowtoGuideDeployRapidResponseTeams.aspx.
  11. 11.
    DeVita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34(9):2463–78.CrossRefPubMedGoogle Scholar
  12. 12.
    Santamaria J. Crises and accountability, RRT from the director. Proceedings of the ANZICS Safety & Quality Conference: the role of intensive care with Rapid Response Teams. 2014; Melbourne, AustraliaGoogle Scholar
  13. 13.
    McGrath RB. In-house cardiopulmonary resuscitation – after a quarter of a century. Ann Emerg Med. 1987;16:1365–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008;299:785–92.CrossRefPubMedGoogle Scholar
  15. 15.
    Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams. A systematic review and meta-analysis. Arch Intern Med. 2010;170(1):18–26.CrossRefPubMedGoogle Scholar
  16. 16.
    Tobin A, Santamaria J. Medical emergency teams are associated with reduced mortality across a major metropolitan health network after two years’ service: a retrospective study using government administrative data. Crit Care. 2012;16:R210.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Smith C, Perkins G, Bullock I, Bion J. Undergraduate training in the care of the acutely ill patient: a literature review. Intensive Care Med. 2007;33:901–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Hillman K. How to do post-hoc response reviews. 6th International symposium on rapid response systems and medical emergency teams. Pittsburgh, USA, 11, 12th May 2010.Google Scholar
  19. 19.
    Westbrook JI, Ling L, Lehnbom EC, Baysari MT, Braithwaite J, Burke R, Conn C, Day RO. What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International J Qual Health Care. 2015;27:1–9.CrossRefGoogle Scholar
  20. 20.
    Russ AL, Fairbanks RJ, Karsh BT, Militello LG, Saleem JJ, Wears RL. The science of human factors: separating fact from fiction. BMJ Quality and Safety. doi:  10.1136/bmjqs-2012-001450
  21. 21.
    Subbe CP, Welch JR. Failure to rescue: using rapid response systems to improve care of the deteriorating patient in hospital. Clinical Risk. 2013;19:6–11.CrossRefGoogle Scholar
  22. 22.
    Cuthbertson BH, Sith GB. A warning on early-warning scores! Br J Anaesth. 2007;98:704–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Chalwin R, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J. 2013;43(9):962–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Helmreich RL, Merritt AC, Wilhelm JA. The evolution of crew resource management training in commercial aviation. Int J Aviat Psychol. 1999;9:19–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Gillon S, Radford S, Chalwin R, DeVita M, Endacott R, Jones D. Crisis resource management, simulation training and the medical emergency team. Crit Care Resusc. 2012;14:227–35.PubMedGoogle Scholar
  26. 26.
    Jones D, Hicks P, Currey J, Holmes J, Fennessy GJ, Hillman K, et al. Findings of the first ANZICS conference on the role of intensive care in rapid response teams. Anaesth Intensive Care. 2015;43:369–79.PubMedGoogle Scholar
  27. 27.
    Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission and death of critically ill adult patients on general hospital wards (Review) Copyright © 2009 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.Google Scholar
  28. 28.
    Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, et al. Introducing critical care outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med. 2004;30:1398–404.CrossRefPubMedGoogle Scholar
  29. 29.
    Gao H, Harrison DA, Parry GJ, Daly K, Subbe CP, Rowan K. The impact of the introduction of CCOS in England: a multicentre interrupted time series analysis. Crit Care. 2007;11:R113.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Harrison D, Gao H, Welch CA, Rowan KM. The effects of critical care outreach services before and after critical care: a matched cohort analysis. J Crit Care. 2010;25:196–204.CrossRefPubMedGoogle Scholar
  31. 31.
    O’Horo JC, Sevilla Berrios RA, Elmer JL, Velagapudi V, Caples SM, Kashyap R, Jensen JB. The role of the primary care team in the rapid response system. J Crit Care. 2015;30:353–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Benin AL, Borgstrom CP, Jenq GY, Roumanis SA, Horwitz LI. Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators. BMJ Qual Saf. 2012;21:391–8.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    The ANZICS-CORE MET. Dose investigators. rapid response team composition, resourcing and calling criteria in Australia. Resuscitation. 2012;83:563–7.CrossRefGoogle Scholar
  34. 34.
    AIHW 2012. Health expenditure Australia 2010-11. Health and welfare expenditure series no. 47. Cat. no. HWE 56. Canberra: AIHW. [cited 2014 August 26] Available from: http://www.aihw.gov.au/publication-detail/?id=10737423009.
  35. 35.
    AIHW 2014. Australian hospital statistics 2012-13. Health services series no. 54. Cat. no. HSE 145. Canberra: AIHW. [cited 2015 August 26] Available from: http://www.aihw.gov.au/publication-detail/?id=60129546922.
  36. 36.
    Y Charts. US Health Care Inflation Rate. Bureau of Labor Statistics. [cited 2015 August 21] Available from http://ycharts.com/indicators/us_health_care_inflation_rate
  37. 37.
    Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, et al. A prospective before-and-after trial of a medical emergency team. Med J Aust. 2003;179:283–7.PubMedGoogle Scholar
  38. 38.
    Australian Bureau of Statistics, Wage Price Index Australia March 2015. [cited 2015 August 9] Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/6345.0/.
  39. 39.
    Nolan JP, Hazinski MF, Billi JE, Boettiger BW, Bossaert L, de Caen AR, et al. Part 1: Executive summary 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2010;81S:e1–e25.CrossRefGoogle Scholar
  40. 40.
    Jones D, Bates S, Warrillow S, Goldsmith D, Kattula A, Way M, et al. Effect of an education program on the utilization of a medical emergency team in a teaching hospital. Intern Med J. 2006;36:231–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Jones D, Mitra B, Barbetti J, Choate K, Leong T, Bellomo R. Increasing the use of an existing medical emergency team in a teaching hospital. Anaesth Intensive Care. 2006;34:731–5.PubMedGoogle Scholar
  42. 42.
    DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL, MERIT. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13:251–4.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Jones DA, Drennan K, Bailey M, Hart GK, Bellomo R, Webb SAR. ANZICS-CORE MET dose investigators. Mortality of rapid response team patients in Australia: a multicentre study. Crit Care Resusc. 2013;15:273–8.Google Scholar
  44. 44.
    Bassily-Marcus A. Early detection of deteriorating patients: leveraging clinical informatics to improve outcome. Crit Care Med. 2014;42:976–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Bonafide CP, Localio AR, Song L, Roberts KE, Nadkarni VM, Priestley M, et al. Cost-benefit analysis of a medical emergency team in a children’s hospital. Pediatrics. 2014;134:235–41.CrossRefPubMedGoogle Scholar
  46. 46.
    Spaulding A, Ohsfeldt R. Rapid response teams and team composition: a cost-effectiveness analysis. Nursing Economics. 2014;32:194–203.Google Scholar
  47. 47.
    Duncan HP, Frew E. Short-term health system costs of paediatric in-hospital acute life-threatening events including cardiac arrest. Resuscitation. 2009;80:529–34.CrossRefPubMedGoogle Scholar
  48. 48.
    Gage H, Kenward G, Hodgetts TJ, Castle N, Ineson N, Shaikh L. Health system costs of in-hospital cardiac arrest. Resuscitation. 2002;54:139–46.CrossRefPubMedGoogle Scholar
  49. 49.
    Ebell MH, Kruse JA. A proposed model for the cost of cardiopulmonary resuscitation. Med Care. 1994;32:640–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Dacey MJ, Mirza ER, Wilcox V, Doherty M, Mello J, Boyer A, Baute R. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med. 2007;35:2076–82.CrossRefPubMedGoogle Scholar
  51. 51.
    Vrtis MC. Cost/benefit analysis of cardiopulmonary resuscitation: a comprehensive study—Part II. Nurs Manage. 1992;23:44–6. 50-41CrossRefPubMedGoogle Scholar
  52. 52.
    Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A. The patient-at-risk team: identifying and managing seriously ill ward patients. Anesthesia. 1999;54:853–60.CrossRefGoogle Scholar
  53. 53.
    Simmes F, Schoonhoven L, Mintjes J, Adang E, van der Hoeven JG. Financial consequences of the implementation of a rapid response system on a surgical ward. J Eval Clin Pract. 2014;20:342–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Weinstein MC. How much are americans willing to pay for a quality-adjusted life year? Med Care. 2008;46(4):343–5.CrossRefPubMedGoogle Scholar
  55. 55.
    Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158:417–25.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care. 2015;19:254. doi:  10.1186/s13054-015-0973-y.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Australian Hospital Statistics 2009-1010. [cited 2015 August 21] Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737419061.
  58. 58.
    Centers for Disease Control and Prevention. Trends in inpatient hospital deaths: National hospital discharge survey, 2000–2010. NCHS Data Brief 118, March 2013. [cited 2015 August 21] Available from: http://www.cdc.gov/nchs/data/databriefs/db118.pdf.
  59. 59.
    Crow S, Fischer AC, Schears RM. Extracorporeal life support: utilization, cost, controversy, and ethics of trying to save lives. Semin Cardiothorac Vasc Anesth. 2009;13:183–91.CrossRefPubMedGoogle Scholar
  60. 60.
    Rana A, Gruessner A, Agopian V, Khalpey Z, Riaz IB, Kaplan B, et al. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150:252–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Layton A, Robinson T, Tucker IB. Economics for today. 3rd ed. South Melbourne: Cengage Learning; 2009.Google Scholar
  62. 62.
    Rogers EM. Diffusion of innovations. 5th ed. New York: Simon and Schuster; 2003.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Complex-Wide Adult Intensive Care, Mater Health ServicesSouth BrisbaneAustralia

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