title: The effect of a staged, emergency department specific rapid response system on reporting of clinical deterioration.
abstract: BACKGROUND
  Despite emerging evidence regarding clinical deterioration in emergency department (ED) patients, the widespread uptake of rapid response systems (RRS) in EDs has been limited.
  
  
  OBJECTIVE
  To evaluate the effect of an ED RRS on reporting of clinical deterioration and determine if there were differences between patients who did, and did not, deteriorate during ED care.
  
  
  METHODS
  A retrospective cross sectional design was used to conduct this single site study in Melbourne, Australia. Stratified random sampling identified 50 patients with shortness of breath, chest pain or abdominal pain per each year studied (2009-2012) giving a total of 600 patients. The intervention was an ED RRS implemented in stages.
  
  
  RESULTS
  The frequency of clinical deterioration was 14.8% (318 episodes/89 patients). Unreported deterioration decreased each year (86.7%; 68.8%; 55.3%; 54.0%, p=0.141). Patients who deteriorated during ED care had a longer median ED length of stay (2.8h; p<0.001), were 31.9% more likely to need hospital admission (p<0.001) and 4.9% more likely to die in hospital (p=0.044).
  
  
  CONCLUSIONS
  A staged ED specific RRS decreased the frequency of unreported clinical deterioration. Controlled multi-site studies of ED specific RRSs are needed to examine the effect of formal ED RRSs on patient outcomes.
authors: Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria 3125, Australia; Eastern Health - Deakin University Nursing & Midwifery Research Centre, 221 Burwood Highway, Burwood, Victoria 3125, Australia; Centre for Quality and Patient Safety Research, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia. Electronic address: julie.considine@deakin.edu.au.
authors: Julie
authors: J
authors: Considine
authors: Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria 3125, Australia. Electronic address: jennifer.rawet@deakin.edu.au.
authors: Jen
authors: J
authors: Rawet
authors: Deakin University, School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Victoria 3125, Australia; Centre for Quality and Patient Safety Research, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia. Electronic address: judy.currey@deakin.edu.au.
authors: Judy
authors: J
authors: Currey
mesh_terms: D015746:Abdominal Pain / Q000628:therapy; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000628:therapy; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004417:Dyspnea / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D057209:Hospital Rapid Response Team; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014739:Victoria
keywords: Emergency medicine; Emergency nursing; Patient safety; Rapid response teams; Risk management