The impact of a nurse led rapid response system on adverse, major adverse events and activation of the medical emergency team

SummaryAimTo identify the relationship between one example of a rapid response system (RRS), specifically, an after-hours Clinical Team Co-Ordinator (CTC), and the incidence of Medical Emergency Team (MET) activations and, adverse and major adverse events in medical patients.MethodA retrospective chart audit of patients’ medical records was undertaken. The intervention group consisted of 150 randomly selected medical patients admitted during three months after the introduction of the CTC after-hours service. The control group consisted of 150 randomly selected medical patients admitted before the introduction of the after-hours CTC service. Multiple logistic regression was used to determine which of the potential predictors, along with the after-hours CTC service, were associated with adverse and major adverse events.ResultsA total of 130 patients (n = 63, 42% control; n = 67, 45% intervention) exhibited physiological abnormalities that should have activated the MET yet it was only activated five times. In total there were 69 adverse events (n = 32, 21% control; n = 36, 25% intervention) and 25 major adverse events (n = 7, 5% control; n = 18, 12% intervention). There were more adverse and major adverse events identified after the introduction of the CTC after-hours service. Changes in heart rate and reduction in Glasgow Coma Scores (GCS) were significant predictors of an adverse event. A low urine output and a drop of two or more in the GCS were significant predictors of a major adverse event.ConclusionsThe introduction of an after-hours CTC service in a specific clinical site was associated with an increase in the identification of adverse and major adverse events in medical patients. Further exploration of nurse-led rapid response systems should be undertaken in different clinical settings.