Listen to me, I really am sick! Patient and family narratives of clinical deterioration before and during rapid response system intervention.

Aim: To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital.

Background: Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability.

The OxyTain Algorithm: An Approach to Airway Management in the Cannot Intubate and Cannot Oxygenate Scenario.

Although rare, cannot intubate and cannot oxygenate situations are challenging acute events. The development of management algorithms, standardized equipment provisions, and appropriate clinical training in the application of front-of-neck access techniques are necessary to optimize procedural success to ensure adequate oxygenation. The OxyTain algorithm is an institutionally developed protocol to manage cannot intubate and cannot oxygenate events.

Medical-setting deaths and the coroner: laws, penalties and guidelines.

We examine the law governing the reporting of medical-setting deaths to the Coroner throughout the Australian states and territories. We use a hypothetical case report to explore the different legal requirements for reporting a medical-setting death and the varying penalties that apply for failing to report a reportable death. It is important for health practitioners to understand the law that applies in the state or territory in which they practice.

Rapid response systems and collective (in)competence: An exploratory analysis of intraprofessional and interprofessional activation factors.

The rapid response system (RRS) is a patient safety initiative instituted to enable healthcare professionals to promptly access help when a patient's status deteriorates. Despite patients meeting the criteria, up to one-third of the RRS cases that should be activated are not called, constituting a "missed RRS call". Using a case study approach, 10 focus groups of senior and junior nurses and physicians across four hospitals in Australia were conducted to gain greater insight into the social, professional and cultural factors that mediate the usage of the RRS.

An evidence-based framework to measure quality of allied health care.

Background: There is no standard way of describing the complexities of allied health (AH) care, or its quality. AH is an umbrella term which excludes medicine and nursing, and variably includes disciplines which provide therapy, diagnostic, or scientific services. This paper outlines a framework for a standard approach to evaluate the quality of AH therapy services.

Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis.

Background: Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs.

Is statin use associated with reduced mortality after pneumonia? A systematic review and meta-analysis.

Objective: The objective of this study was to perform a systematic review and meta-analysis of the effects of statins on mortality following pneumonia.

Methods: We searched MEDLINE, EMBASE, BIOSIS, Cochrane CENTRAL Register of Controlled Trials, Cambridge Scientific Abstracts, BIOSIS, and Scopus. Studies were included if they involved: participants ≥18 years of age; patients with community-acquired pneumonia; current statin users; and reported overall or adjusted mortality after pneumonia.

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 in a multi-campus Australian metropolitan healthcare service.

Objective: To explore the causes of failure to activate the rapid response system (RRS). The organisation has a recognised incidence of staff failing to act when confronted with a deteriorating patient and leading to adverse outcomes.

Design: A multi-method study using the following: a point prevalence survey to determine the incidence of abnormal simple bedside observations and activation of the rapid response team by clinical staff; a prospective audit of all patients experiencing a cardiac arrest, unplanned intensive care unit admission or death over an 8-week period; structured interviews of staff to explore cognitive and sociocultural barriers to activating the RRS.

Bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an Early Warning Score protocol.

Background: Failure to comply with clinical protocols and failure of communication to ensure delivery of the most appropriate timely clinical responses to patients whose conditions are acutely deteriorating have been shown to be significant causative factors associated with inhospital adverse events.

Objective: To determine whether automated clinical alerts increase compliance with an Early Warning Score (EWS) protocol and improve patient outcomes.

Methods: We performed a historically controlled study of bedside electronic capture of observations and automated clinical alerts.

Why don't hospital staff activate the rapid response system (RRS)? How frequently is it needed and can the process be improved?

Background: The rapid response system (RRS) is a process of accessing help for health professionals when a patient under their care becomes severely ill. Recent studies and meta-analyses show a reduction in cardiac arrests by a one-third in hospitals that have introduced a rapid response team, although the effect on overall hospital mortality is less clear. It has been suggested that the difficulty in establishing the benefit of the RRS has been due to implementation difficulties and a reluctance of clinical staff to call for additional help.

How I nearly MET my maker: a story of clinical futile cycles and survival.

In this series, the articles have highlighted a variety of implementation methods and uses of rapid response systems (RRSs). They have described how RRSs have been uniquely tailored to the organizations' culture and clinical environments, with largely positive results following implementation. In this article, Dr.

Rapid response systems: a mandatory system of care or an optional extra for bedside clinical staff.

Two articles in this issue describe different approaches to implementing a rapid response system--one approach involving a wide-ranging marketing plan, the other entailing a policy change to make activation mandatory.

"Identifying the hospitalised patient in crisis"--a consensus conference on the afferent limb of rapid response systems.

Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring.

Methods: A consensus conference of international experts in safety, RRS, healthcare technology, education, and risk prediction was convened to review current knowledge and opinion on clinical monitoring.