Barriers to calling for urgent assistance despite a comprehensive pediatric rapid response system.

TitleBarriers to calling for urgent assistance despite a comprehensive pediatric rapid response system.
Publication TypeJournal Article
Year of Publication2014
AuthorsRoberts KE, Bonafide CP, Paine CW, Paciotti B, Tibbetts KM, Keren R, Barg FK, Holmes JH
JournalAm J Crit Care
Volume23
Issue3
Pagination223-9
Date Published2014 May
ISSN1937-710X
KeywordsAdolescent, Adult, Attitude of Health Personnel, Child, Child, Preschool, Communication Barriers, Critical Care, Employee Discipline, Female, Heart Arrest, Hospital Rapid Response Team, Hospitals, Pediatric, Hospitals, Urban, Humans, Infant, Intensive Care Units, Pediatric, Interprofessional Relations, Male, Middle Aged, Philadelphia, Qualitative Research, Self Efficacy, Tertiary Care Centers, Treatment Outcome
Abstract

BACKGROUND: Rapid response systems (RRSs) aim to identify and rescue hospitalized patients whose condition is deteriorating before respiratory or cardiac arrest occurs. Previous studies of RRS implementation have shown variable effectiveness, which may be attributable in part to barriers preventing staff from activating the system.

OBJECTIVE: To proactively identify barriers to calling for urgent assistance that exist despite recent implementation of a comprehensive RRS in a children's hospital.

METHODS: Qualitative study using open-ended, semistructured interviews of 27 nurses and 30 physicians caring for patients in general medical and surgical care areas.

RESULTS: The following themes emerged: (1) Self-efficacy in recognizing deteriorating conditions and activating the medical emergency team (MET) were considered strong determinants of whether care would be appropriately escalated for children in a deteriorating condition. (2) Intraprofessional and interprofessional hierarchies were sometimes challenging to navigate and led to delays in care for patients whose condition was deteriorating. (3) Expectations of adverse interpersonal or clinical outcomes from MET activations and intensive care unit transfers could strongly shape escalation-of-care behavior (eg, reluctance among subspecialty attending physicians to transfer patients to the intensive care unit for fear of inappropriate management).

CONCLUSIONS: The results of this study provide an in-depth description of the barriers that may limit RRS effectiveness. By recognizing and addressing these barriers, hospital leaders may be able to improve the RRS safety culture and thus enhance the impact of the RRS on rates of cardiac arrest, respiratory arrest, and mortality outside the intensive care unit.

DOI10.4037/ajcc2014594
Alternate JournalAm. J. Crit. Care
PubMed ID24786810