Standardizing Care Processes Using Evidence-Based Strategies: Implementation of a Rapid Response System in Belgian Hospitals

Abstract

Since the turn of the millennium, the safety of hospital inpatients has become an important subject of research. Problems associated with in-hospital preventable deaths such as poor clinical monitoring, diagnostic errors, and inadequate therapy are most likely to occur in general wards. Studies demonstrate the presence of a substantial window between physiological instability and cardiac arrest where timely intervention could influence patient outcomes. Accordingly, the European Resuscitation Council has emphasized the importance of recognizing those at risk of cardiac arrest in the hope of preventing the need for resuscitation efforts through early treatment. However, in-hospital physiological instability is often missed, misinterpreted, and/or mismanaged by hospital staff. Moreover, a considerable number of preventable in-hospital deaths may be linked to poor practice and multiple failures of the various systems, reflecting environmental contexts of care that are discussed elsewhere in this book. This chapter describes five possible short-term outcomes that are influenced by patient and hospital characteristics as well as processes of care because of clinically deteriorating patient on the general wards. We propose the concept of rapid response system (RSS) as an umbrella term for all approaches aimed at improving detection and interpretation of in-hospital clinical deterioration and enhancing communication between caregivers around deterioration and the initiation of an appropriate response in a timely manner. We describe and discuss the theoretical base and our experiences with implementing an RRS in Belgian hospitals within a randomized study design to study and improve outcomes. An evidence-based strategy was used to standardize care processes on general wards. During this research project, we identified barriers and facilitators at various levels that could have a possible impact on the adoption of a rapid response system on the general ward in acute hospitals. We formulate a conclusion based on previous studies and our research findings.