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Title: Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review
Austin Authors: Chua, Wei Ling;See, Min Ting Alicia;Legio-Quigley, Helena;Jones, Sok Ying;Tee, Augustine;Liaw, Sok Ying
Affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Saw Swee Hock School of Public Health, National University of Singapore, Singapore
London School of Hygiene and Tropical Medicine, London, UK
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
University of Melbourne, Melbourne, VIC, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
Issue Date: 21-Nov-2017
Date: 2017-11-21
Publication information: International Journal for Quality in Health Care 2017; 21:1-18
Abstract: PURPOSE: To synthesize factors influencing the activation of the rapid response system (RRS) and reasons for suboptimal RRS activation by ward nurses and junior physicians. DATA SOURCES: Nine electronic databases were searched for articles published between January 1995 and January 2016 in addition to a hand-search of reference lists and relevant journals. STUDY SELECTION: Published primary studies conducted in adult general ward settings and involved the experiences and views of ward nurses and/or junior physicians in RRS activation were included. DATA EXTRACTION: Data on design, methods and key findings were extracted and collated. RESULTS OF DATA SYNTHESIS: Thirty studies were included for the review. The process to RRS activation was influenced by the perceptions and clinical experiences of ward nurses and physicians, and facilitated by tools and technologies, including the sensitivity and specificity of the activation criteria, and monitoring technology. However, the task of enacting the RRS activations was challenged by seeking further justification, deliberating over reactions from the rapid response team and the impact of workload and staffing. Finally, adherence to the traditional model of escalation of care, support from colleagues and hospital leaders, and staff training were organizational factors that influence RRS activation. CONCLUSION: This review suggests that the factors influencing RRS activation originated from a combination of socio-cultural, organizational and technical aspects. Institutions that strive for improvements in the existing RRS or are considering to adopt the RRS should consider the complex interactions between people and the elements of technologies, tasks, environment and organization in healthcare settings.
DOI: 10.1093/intqhc/mzx149
Journal: International Journal for Quality in Health Care
PubMed URL:
Type: Journal Article
Subjects: clinical deterioration
early warning scoring system
human factors
patient safety
rapid response system
systematic review
Appears in Collections:Journal articles

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