In a nutshell this is what the expert meeting convened by the International Society for Rapid Response Systems concluded this week in Manchester.
Rapid Response Systems look after patients in hospital by looking out for early signs of patients developing complications and in case of deterioration bring the skills from Intensive Care Units right to the bed side of the patient. Teams are usually called by nurses or doctors on general wards and arrive within minutes from the Intensive Care Unit, examine patients and then start treatments or when needed take the patient straight to Intensive Care. Other terms that describe the same idea are ‘Medical Emergency Team’, ‘Rapid Response Team’ or ‘Critical Care Outreach team’.
A group of hospital safety specialists has now recommended that calling such a team is something that should be open not just to healthcare professionals but also to all patients and families who are in hospital.
About 10% of patients suffer a complication if they are admitted to hospital. About half of these complications are predictable and preventable. In many cases early recognition of a complication is key. Faster treatment is often more effective than the same treatment given late. And often nobody knows before the patient or those close to them when something is going wrong.
On the 9th and 10th of July this week Manchester hosted the annual conference of the International Society for Rapid Response Systems in association with the UK Patient Safety congress with big name speakers such as Kevin Fong, Charles Vincent, Helen Hogan and others. The meeting was preceded by a two-day consensus conference on measurements: How should we measure that the patients who are looked after by a rapid response system are safe? What are the things that would make us believe that complications are picked up early and the system is working? How do we know that patients don’t die from conditions such as bleeding or severe infection where fast treatment can save lives? How do we report that patients are safe so that everybody understands the numbers?
Experts discussed evidence for many different ways on how to measure good quality care of patients who deteriorate including the number of cardiac arrests that happen in patients who are known to be unwell and the need for a fast move of patients to an intensive care unit if things are going bad. But we also know that nobody is perfect: sometimes even the best and most good-willing doctors and nurses might overlook that someone is getting really unwell. In these circumstances patients and their relatives are the only ones that might realise an impending catastrophe. But what can they do if they can’t make themselves heard with their own medical team? Patients might get desperate. And there are examples how they phone the hospital to get help – while being in hospital. Alison Philips told us about her harrowing time in intensive care and the slow recovery in hospital that was fraught with complications. She summarised for all of us:
'Surely we all have the right to save our own lives'.There are already examples of patients and families activating Rapid Response teams directly. Two of experts in this field were part of the consensus group: Helen Haskell son Lewis died in hospital after signs of deterioration were repeatedly missed. She campaigned to make patient activated rapid response a law in South Carolina. And Mandy Odell has developed the concept of ‘Call for Concern’ (C4C) at her hospital in Reading. She presented compelling evidence for the feasibility of a patient and family activated Rapid Response: their team is very active, but patients and families are an important source of their information about deteriorations. If a patients is worried they are there to help or find someone who can. Who calls them: mostly mothers and daughters of patients ! Do they get called all the time? Not that often – patients make up only about 1% of all of their calls, so this is doable! Time-wasters? Very rare – patients and families understand how busy staff is and they call only when they really can’t see another way.
Is there a lot of research to show that this makes hospital safer? We know that patients appreciate this type of service, but we are not sure whether it makes hospitals safer. Most research has been done only in one hospital at time but there are now hospital in Europe, the US and Australia that operate this type of system. Measuring safety of care is complicated and working out what makes a difference is often impossible if there are several initiatives trying to improve things at the same time. There are other types of evidence: when we discussed the topic recently at a hospital committee it was amazing how many of the members of the committee had experienced a related scenario: a family member or friend was admitted to hospital. They were not well at all. The team on the ward was too busy. And they decided to support their relative or friend and call someone else working in the hospital for help. This is patient/family activated rapid response in all but name. And we are already practicing it!
What is the learning? If this type of system increases patient satisfaction, has the potential to enhance safety and is already informally part of our own routines as healthcare professionals then it is difficult to make an ethical argument to not recommend implementation for patients and families. And this is what the experts did. As one of less than a dozen measures that safety of deteriorating patients will be measured against the reporting of patient and family activated rapid response was recommended as an essential way to measure quality care. And hospitals should keep track how often patients do activate the system. You can see on the linked photo that there was wide spread support for this measure in a linked session at the congress with standing room only when the recommendations were announced.
The expert group will refine the wording of the consensus document over the next few months. But an important first step has been taken to make the voice of patients in hospital more audible.
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