title: The impact of a nurse led rapid response system on adverse, major adverse events and activation of the medical emergency team.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  The 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.
authors: School of Nursing and Midwifery, Griffith University - Gold Coast campus, Parklands Drive, Southport, QLD 4215, Australia. Electronic address: d.massey@griffith.edu.au.
authors: Debbie
authors: D
authors: Massey
authors: School of Nursing and Midwifery, Griffith University - Nathan campus, Kessels Road, Nathan, QLD 4111, Australia; Intensive Care Unit, Princess Alexandra Hospital, Ipswich Road, Woolloongabba QLD 4102, Australia; School of Health Sciences, City University London, London, United Kingdom; NHMRC Centre for Research Excellence in Nursing (NCREN), Griffith Health Institute, Griffith University, Australia. Electronic address: l.aitken@griffith.edu.au.
authors: Leanne M
authors: LM
authors: Aitken
authors: School of Nursing and Midwifery, Griffith University - Gold Coast campus, Parklands Drive, Southport, QLD 4215, Australia; NHMRC Centre for Research Excellence in Nursing (NCREN), Griffith Health Institute, Griffith University, Australia. Electronic address: w.chaboyer@griffith.edu.au.
authors: Wendy
authors: W
authors: Chaboyer
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D016022:Case-Control Studies; D004630:Emergencies / Q000453:epidemiology / Q000451:nursing*; D004636:Emergency Service, Hospital; D005260:Female; D057209:Hospital Rapid Response Team / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009746:Nursing, Team / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Adverse events; After-hours; Major adverse events; Patient safety; Ramp up rapid response system