title: 'Score to Door Time', a benchmarking tool for rapid response systems: a pilot multi-centre service evaluation.
abstract: BACKGROUND
  Rapid Response Systems were created to minimise delays in recognition and treatment of deteriorating patients on general wards. Physiological 'track and trigger' systems are used to alert a team with critical care skills to stabilise patients and expedite admission to intensive care units. No benchmarking tool exists to facilitate comparison for quality assurance. This study was designed to create and test a tool to analyse the efficiency of intensive care admission processes.
  
  
  METHODS
  We conducted a pilot multicentre service evaluation of patients admitted to 17 intensive care units from the United Kingdom, Ireland, Denmark, United States of America and Australia. Physiological abnormalities were recorded via a standardised track and trigger score (VitalPAC™ Early Warning Score). The period between the time of initial physiological abnormality (Score) and admission to intensive care (Door) was recorded as 'Score to Door Time'. Participants subsequently suggested causes for admission delays.
  
  
  RESULTS
  Score to Door Time for 177 admissions was a median of 4:10 hours (interquartile range (IQR) 1:49 to 9:10). Time from physiological trigger to activation of a Rapid Response System was a median 0:47 hours (IQR 0:00 to 2:15). Time from call-out to intensive care admission was a median of 2:45 hours (IQR 1:19 to 6:32). A total of 127 (71%) admissions were deemed to have been delayed. Stepwise linear regression analysis yielded three significant predictors of longer Score to Door Time: being treated in a British centre, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and increasing age. Binary regression analysis demonstrated a significant association (P < 0.045) of APACHE II scores >20 with Score to Door Times greater than the median 4:10 hours.
  
  
  CONCLUSIONS
  Score to Door Time seemed to be largely independent of illness severity and, when combined with qualitative feedback from centres, suggests that admission delays could be due to organisational issues, rather than patient factors. Score to Door Time could act as a suitable benchmarking tool for Rapid Response Systems and helps to delineate avoidable organisational delays in the care of patients at risk of catastrophic deterioration.
authors.affiliation: Department of Anaesthesia and Critical Care, Weston General Hospital, Grange Road, Uphill, Somerset, BS23 4TQ England, UK. oglesbyk@doctors.org.uk
authors.forename: Kieran J
authors.initials: KJ
authors.lastname: Oglesby
authors.forename: Lesley
authors.initials: L
authors.lastname: Durham
authors.forename: John
authors.initials: J
authors.lastname: Welch
authors.forename: Christian P
authors.initials: CP
authors.lastname: Subbe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000379:methods*; D016638:Critical Illness; D005260:Female; D057209:Hospital Rapid Response Team / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index; D013997:Time Factors; D014218:Triage / Q000592:standards