Skip to main content
SpringerLink
Log in
Book cover

Textbook of Rapid Response Systems pp 147–158Cite as

Barriers to the Implementation of RRS

  • Chapter
  • First Online:

Abstract

While implementing a rapid Response System may make some sense on paper, ultimately it represents changes in organization, workflow, and culture of an organization. These changes may give rise to barriers to implementation, improvement, and sustaining changes. Indeed, one organization reported that there were 1.1 disruptive events per team activation. In the same report less than 1 % of the disruptions had clinical impact, but the remainder certainly led to an unfavorable cultural environment even though lives were saved. In this chapter, potential barriers to success of a Rapid Response System are discussed. Suggestions for overcoming them are offered, with the caveat that there is a lack of data in this realm of endeavor.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Lee A, Bishop G, Hillman KM, Daffurn K. The medical emergency team. Anaesth Intensive Care. 1995;23:183–6.

    CAS  PubMed  Google Scholar 

  2. Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med. 2011;365:139–46.

    Article  CAS  PubMed  Google Scholar 

  3. Bristow PJ, Hillman KM, Chey T, et al. Rates of in-hospital arrests, deaths, and intensive care admissions: the effect of a medical emergency team. Med J Aust. 2000;173:236–40.

    CAS  PubMed  Google Scholar 

  4. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324:387–90.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Baxter AD, Cardinal P, Hooper J, Patel R. Medical emergency teams at The Ottawa Hospital: the first two years. Can J Anaesth. 2008;55(4):223–31.

    Article  PubMed  Google Scholar 

  6. Bellomo R, Goldsmith D. Postoperative serious adverse events in a teaching hospital: a prospective study. Med J Aust. 2002;176:216–8.

    PubMed  Google Scholar 

  7. Chen J, Flabouris A, Bellomo R, Hillman K, Finfer S, MERIT Study Investigators in the Simpson Centre and the ANZICS Clinical Trials Group. The relationship between early emergency team calls and serious adverse events. Crit Care Med. 2009;37:148–53.

    Article  PubMed  Google Scholar 

  8. MERIT Study Investigators. Introduction of the medical emergency team: a cluster-randomised controlled trial. Lancet. 2005;365:2091–7.

    Article  Google Scholar 

  9. Chen J, Flabouris A, Bellomo R, Hillman K, Finfer S, MERIT Study Investigators in the Simpson Centre and the ANZICS Clinical Trials Group. The impact of introducing medical emergency teams on the documentation of vital signs. Resuscitation. 2009;80:35–43.

    Article  PubMed  Google Scholar 

  10. Institute of Medicine. To err is human: building a safer health system. In: Kohn LT, Corrigan JM, Donaldson MS, editors. Washtington, DC: National Academy Press; 2000.

    Google Scholar 

  11. Yourstone SA, Smith HL. Managing system errors and failures in health care organizations: suggestions for practice and research. Health Care Manage Rev. 2002;27(1):50–61.

    Article  PubMed  Google Scholar 

  12. Needham DM, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Dennison Himmelfarb CR, Desai SV, Shanholtz C, Brower RG, Pronovost PJ. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012;344:e2124.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bratzler DW, Houck PM, Richards C, et al. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005;140(2):174–82.

    Article  PubMed  Google Scholar 

  14. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Oppdam H, Silvester W, Doolan L, Gutteridge G. Prospective controlled trial of effects of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32:916–21.

    Article  PubMed  Google Scholar 

  15. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W, Doolan L, Gutteridge G. A prospective before-and-after trial of a medical emergency team. Med J Aust. 2003;179(6):283–9.

    PubMed  Google Scholar 

  16. Goldhill DR, Worthington L, Mulcahy A, Taring M, Sumner A. The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia. 1999;54:853–60.

    Article  CAS  PubMed  Google Scholar 

  17. Knox GE, Simpson KR. Teamwork: the fundamental building block of high-reliability organizations and patient safety. In: Youngberg BJ, Hatlie MJ, editors. Patient safety handbook. Boston: Jones & Bartlett; 2004. p. 379–415.

    Google Scholar 

  18. Baker DP, Day R, Salas E. Teamwork as an essential component of high-reliability organizations. Health Serv Res. 2006;41(4 Pt 2):1576–98.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Nathens AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA. 2000;283:1990–4.

    Article  CAS  PubMed  Google Scholar 

  20. Lecky F, Woodford M, Yates DW. Trends in trauma care in England and Wales 1989–97. UK Trauma Audit Research Network. Lancet. 2000;355:1771–5.

    Article  CAS  PubMed  Google Scholar 

  21. Mullins RJ, Veum-Stone J, Helfand M, Zimmer-Gembeck M, Trunkey D. Outcome of hospitalized patients after institution of a trauma system in an urban area. JAMA. 1994;27:1919–24.

    Article  Google Scholar 

  22. Plsek PE, Greenhalgh T. The challenge of complexity in health care. BMJ. 2001;323:625–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Eccles FR, Grimshaw J. Why does primary care need more implementation research? Fam Pract. 2001;18:353–5.

    Article  PubMed  Google Scholar 

  24. Dellinger RP. Fundamental critical care support: another merit badge or more? Crit Care Med. 1996;24:556–7.

    Article  CAS  PubMed  Google Scholar 

  25. Cook RI, Render M, Woods DD. Gaps in the continuity of care and progress on patient safety. BMJ. 2000;320:791–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Micthell A, Schatz M, Francis H. Designing a critical care nurse-led rapid response team using only available resources: 6 years later. Crit Care Nurse. 2014;34(3):41–55.

    Article  Google Scholar 

  27. The Concord Medical Emergency Team (MET) incidents study investigators. Incidents resulting from staff leaving normal duties to attend medical emergency team calls. Med J Aust. 2014;201:528–31. doi:10.5694/mja14.00647.

    Article  Google Scholar 

  28. Schneider EC, Lieberman T. Publicly disclosed information about the quality of health care: response of the US public. Qual Health Care. 2001;10:96–103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Hillman KM, Lilford R, Braithwaite J. Patient safety and rapid response systems. Med J Aust. 2014;201:654–6.

    Article  PubMed  Google Scholar 

  30. Beyea SC. Implications of the 2004 National Patient Safety Goals. AORN J. 2003;78:834–6.

    Article  PubMed  Google Scholar 

  31. Joint Commission on Accreditation of Healthcare Organizations. 2008 National Patient Safety Goals. Jt Comm Persspect. 2007;27:10–22.

    Google Scholar 

  32. Griffith JR, Knutzen SR, Alexander JA. Structural versus outcomes measures in hospitals: a comparison of joint commission and medicare outcomes scores in hospitals. Qual Manag Health Care. 2002;10:29–38.

    Article  PubMed  Google Scholar 

  33. Landis NT. Government finds fault with hospital quality review by joint commission and states. Am J Health Syst Pharm. 1999;56:1699–700.

    CAS  PubMed  Google Scholar 

  34. Scanlon M. Computer physician order entry and the real world: we’re only humans. Jt Comm J Qual Saf. 2004;30:342–6.

    Article  PubMed  Google Scholar 

  35. Pugliese G. In search of safety: an interview with Gina Pugliese. Interview by Alison P. Smith. Nurs Econ. 2002;20:6–12.

    Google Scholar 

  36. Cors WK. Physician executives must leap with the frog. Accountability for safety and quality ultimately lie with the doctors in charge. Physician Exec. 2001;27:14–6.

    CAS  PubMed  Google Scholar 

  37. Foraida M, DeVita M, Braithwaite RS, Stuart S, Brooks MM, Simmons RL. Improving the utilization of medical crisis teams (Condition C) at an urban tertiary care hospital. J Crit Care. 2003;18:87–94.

    Article  PubMed  Google Scholar 

  38. Hourihan F, Bishop G, Hillman KM, Daffurn K, Lee A. The medical emergency team: a new strategy to identify and intervene in high-risk patients. Clin Intensive Care. 1995;6:269–72.

    Article  Google Scholar 

  39. Lee KH, Angus DC, Abramson NS. Cardiopulmonary resuscitation: what cost to cheat death? Crit Care Med. 1996;24:2046–52.

    Article  CAS  PubMed  Google Scholar 

  40. Thomas K, VanOyen Force M, Rasmussen D, Dodd D, Whildin S. Rapid response team: challenges, solutions, benefits. Crit Care Nurse. 2007;27(1):20–7.

    Google Scholar 

  41. Bonafide CP, Localio AR, Song L, Roberts KE, Nadkarni VM, Priestley M, Paine CW, Zander M, Lutts M, Brady PW, Keren R. Cost-benefit analysis of a medical emergency team in a children’s hospital. Pediatrics. 2014;134(2):235–41.

    Article  PubMed  Google Scholar 

  42. Dacey MJ, Mirza ER, Wilcox V, Doherty M, Mello J, Boyer A, Gates J, Brothers T, Baute R. The effect of a rapid response team on major clinical outcome measures in a community hospital. Crit Care Med. 2007;35(09):2076–82.

    Article  PubMed  Google Scholar 

  43. Jones D, Baldwin I, Mcintyre T, et al. Nurses’ attitudes to a medical emergency team service in a teaching hospital. Qual Saf Health Care. 2006;15:427–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Azzopardi P, Kinney S, Moulden A, Tibballs J. Attitudes and barriers to a Medical Emergency Team system at a tertiary paediatric hospital. Resuscitation. 2011;82(2):167–74.

    Article  PubMed  Google Scholar 

  45. Shearer B, Marshall S, Buist M, et al. What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system I a multi-campus Australian healthcare service. BMJ Qual Saf. 2012;21:569–75.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Boniatti M, Azzolini N, Viana M, et al. Delayed medical emergency team calls and associated outcomes. Crit Care Med. 2014;42(1):26–30.

    Article  PubMed  Google Scholar 

  47. Trinkle RM, Flabouris A. Documenting rapid response system afferent limb failure and associated patient outcomes. Resuscitation. 2011;82(7):810–4.

    Article  PubMed  Google Scholar 

  48. Calzavacca P, Licari E, Tee A, et al. The impact of rapid response system on delayed emergency team activation patient characteristics and outcomes—a follow-up study. Resuscitation. 2010;81(1):31–5.

    Article  PubMed  Google Scholar 

  49. McQuillan P, Pilkington S, Alan A, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998;316:1853–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Goldhill DR, White SA, Sumner A. Physiological values and procedures in the 24 hours before ICU admission from the ward. Anaesthesia. 1999;54:529–34.

    Article  CAS  PubMed  Google Scholar 

  51. Reason J. Combating omission errors through task analysis and good reminders. Qual Saf Health Care. 2002;11:40–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Davies O, DeVita MA, Ayinla R, Perez X. Barriers to activation of the rapid response system. Resuscitation. 2014;85(11):1557–61.

    Article  PubMed  Google Scholar 

  53. Hillman K, Alexandrou E, Flabouris M, et al. Clinical outcome indicators in acute hospital medicine. Clin Intensive Care. 2000;11:89–94.

    Article  Google Scholar 

  54. Stevens J, Johansson A, Lennes I, Hsu D, Tess A, Howell M. Long-term culture change related to rapid response system implementation. Med Educ. 2014;48(12):1211–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Critical Care Medicine—Internal Medicine, Adult Critical Care Internal Medicine/Emergency Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Oluwaseun Davies MD

  2. Department of Surgery, Critical Care, Harlem Hospital Center, 506 Lenox Avenue, New York, NY, 10037, USA

    Michael A. DeVita MD, FCCM, FRCP

  3. Department of Internal Medicine, Critical Care, Harlem Hospital Center, 506 Lenox Avenue, New York, NY, 10037, USA

    Michael A. DeVita MD, FCCM, FRCP

  4. The Simpson Centre for Health Services Research, South Western Sydney Clinical School, UNSW Sydney, the Ingham Institute for Applied Medical Research and Intensive Care, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia

    Ken Hillman MBBS, FRCA, FCICM, FRCP, MD

Authors
  1. Oluwaseun Davies MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael A. DeVita MD, FCCM, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken Hillman MBBS, FRCA, FCICM, FRCP, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ken Hillman MBBS, FRCA, FCICM, FRCP, MD .

Editor information

Editors and Affiliations

  1. Department of Surgery, Critical Care, Harlem Hospital Center, New York, New York, USA

    Michael A. DeVita

  2. The Simpson Centre for Health Services Research, South Western Sydney Clinical School, UNSW Sydney, the Ingham Institute for Applied Medical Research and Intensive Care, Liverpool Hospital, Liverpool BC, New South Wales, Australia

    Ken Hillman

  3. Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia

    Rinaldo Bellomo

  4. Royal Berkshire NHS Foundation Trust, Reading, Berkshire, United Kingdom

    Mandy Odell

  5. Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia

    Daryl A. Jones

  6. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Bradford D. Winters

  7. Department of Anesthesia, Stanford University School of Medicine, Palo Alto, California, USA

    Geoffrey K. Lighthall

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Davies, O., DeVita, M.A., Hillman, K. (2017). Barriers to the Implementation of RRS. In: DeVita, M., et al. Textbook of Rapid Response Systems. Springer, Cham. https://doi.org/10.1007/978-3-319-39391-9_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-39391-9_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-39389-6

  • Online ISBN: 978-3-319-39391-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation