title: Expanding the scope of Critical Care Rapid Response Teams: a feasible approach to identify adverse events. A prospective observational cohort.
abstract: BACKGROUND
  Adverse events (AEs) affect 3-12% of hospitalised patients. These are estimates from a labour-intensive chart review process,which is not feasible outside research. Clinical deterioration on the wards triggers a rapid response teams (RRTs) consult and can be used to identify an AE prospectively.
  
  
  OBJECTIVE
  To demonstrate the feasibility of using RRT to detect AEs and compare this methodology to the rates reported using an electronic safety reporting system.
  
  
  METHODS
  Prospective observational cohort of RRT consults. Three independent physicians reviewed all cases for the occurrence of an AE and its preventability. We summarise AEs as rates per 1000 patient-days, and compared the rates between RRT and the safety reporting system using a Poisson model.
  
  
  RESULTS
  There were 8713 hospital admissions, with 531 RRT consults and 247 (2.8%) cases included. Forty-four (17.8%) and 35 cases (14.2%) were judged as AEs and preventable AEs, respectively. RRT identified 0.52 AE/1000 patient-days, compared with 0.21 AE/1000 patient-days detected through the electronic safety reporting system (rate ratio 2.4, 95% CI 1.4 to 4.2, p=0.0014). Patients in surgical wards had more AEs (0.83/1000 vs 0.36/1000, p<0.01) and preventable AEs (0.70 vs 0.21, p<0.01) than patients in medical wards. Agreement for AE (κ 0.46, 95% CI 0.39 to 0.53) and preventable AE (κ 0.47, 95% CI 0.40 to 0.53) was moderate among reviewers.
  
  
  CONCLUSIONS
  Reviewing RRT consults identified a high proportion of AEs and preventable AEs. This methodology detected twice as many AEs as the hospital's safety reporting system. RRT clinicians provide a complementary and more sensitive mechanism than traditional safety reporting systems to identify possible AEs in hospitals.
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Andre Carlos Kajdacsy-Balla
authors.initials: AC
authors.lastname: Amaral
authors.affiliation: Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: McDonald
authors.affiliation: Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xiong
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kaveh G
authors.initials: KG
authors.lastname: Shojania
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Chapman
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D004282:Documentation / Q000379:methods*; D005260:Female; D057209:Hospital Rapid Response Team / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000145:classification / Q000706:statistics & numerical data*; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies
keywords: Adverse events, epidemiology and detection; Chart review methodologies; Human error; Incident reporting; Medical emergency team