"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. Using established consensus procedures, four topic areas were addressed: (1) To what extent do physiologic abnormalities predict risk for patient deterioration? (2) Do workload changes and their potential stresses on the healthcare environment increase patient risk in a predictable manner? (3) What are the characteristics of an "ideal" monitoring system, and to what extent does currently available technology meet this need? and (4) How can monitoring be categorized to facilitate comparing systems?


CONCLUSIONS
The major findings include: (1) vital sign aberrations predict risk, (2) monitoring patients more effectively may improve outcome, although some risk is random, (3) the workload implications of monitoring on the clinical workforce have not been explored, but are amenable to study and should be investigated, (4) the characteristics of an ideal monitoring system are identifiable, and it is possible to categorize monitoring modalities. It may also be possible to describe monitoring levels, and a system is proposed.
DeVita
Michael A
MA
West Penn Allegheny Health System, Pittsburgh, PA, USA.
Smith
Gary B
GB
Adam
Sheila K
SK
Adams-Pizarro
Inga
I
Buist
Michael
M
Bellomo
Rinaldo
R
Bonello
Robert
R
Cerchiari
Erga
E
Farlow
Barbara
B
Goldsmith
Donna
D
Haskell
Helen
H
Hillman
Kenneth
K
Howell
Michael
M
Hravnak
Marilyn
M
Hunt
Elizabeth A
EA
Hvarfner
Andreas
A
Kellett
John
J
Lighthall
Geoffrey K
GK
Lippert
Anne
A
Lippert
Freddy K
FK
Mahroof
Razeen
R
Myers
Jennifer S
JS
Rosen
Mark
M
Reynolds
Stuart
S
Rotondi
Armando
A
Rubulotta
Francesca
F
Winters
Bradford
B
D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007297:Inpatients; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards*; D012151:Resuscitation; D055986:Vital Signs