Nursing and Medical Staff Perceptions of a Hospital-Based Medical Emergency Response Team

Purpose:

Timely recognition and appropriate response to clinical deterioration has been at the forefront of international safety and quality agendas. Rapid response systems have been widely implemented to improve patient outcomes, yet evidence is inconclusive in confirming the effectiveness of these approaches consistently across a range of settings ^{[1, 2]}.  Other studies have identified rapid response teams are often underused by staff ^{[3, 4]}. The purpose of this study was to explore and compare nursing and medical staff perceptions of a mature rapid response system at a large tertiary hospital using the Australian Commission on Safety and Quality in Health Care benchmarking tool. Specifically, the study objectives were to examine perceptions of barriers to Medical Emergency Response Team (MERT) activation, effectiveness of the MERT in response to clinical deterioration, and effectiveness of teamwork and communication during a MERT call.

Methods:

A single site, cross-sectional survey design was used to explore staff perceptions of the MERT. This study was part of a larger program of research exploring nursing patient assessment practices in the acute care setting.

The single-centre study was conducted at a 929-bed quaternary and tertiary referral teaching hospital located in Southeast Queensland, Australia providing services to diverse clinical specialities. The sample included 434 registered nurses (RNs) and 190 medical staff involved in the care of patients at risk of clinical deterioration from a sampling frame of 40 clinical units.

Results:

 Overall, while both groups rated the MERT positively, RNs perceived the MERT as more effective in managing clinical deterioration (p = .04) and perceived greater MERT teamwork and communication (p = .02) compared to their medical colleagues. Interestingly, 70.3% of RNs and 70.1% of medical staff indicated they would contact the patient’s treating physician before activating the MERT. Both groups similarly rated perceived barriers to MERT activation as relatively low overall. A significant minority of RNs (17.1%) and a smaller proportion of medical staff (7.9%) were reluctant to activate the MERT because they feared criticism if their patient was not found to be critically unwell (p< .01).

 Conclusion:

Quality improvement and patient safety are imperative clinical targets supported by policy, patient advocacy, and healthcare professional groups. This project is a collaborative partnership between health service managers, clinical managers, clinicians and university and clinical researchers that has formed in response to this significant health service problem. Findings from this study will contribute to our understanding of integral factors related to capacity to rescue of clinical frontline staff, patient safety, and the rate of failure to rescue of patients in acute care wards. Further research is needed to determine which improvement strategies are more consistently effective and sustainable in recognition and response to clinical deterioration that incorporates perceptions of frontline staff.

References

1. Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C (2010). Rapid Response Teams. A systematic review and meta-analysis. Archives of Internal Medicine, 170(1):18-26.

2. Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM (2013). Rapid-response systems as a patient safety strategy: a systematic review. Annals of Internal Medicine, 5; 158 (5 Pt 2): 417-25.

3. Salamonson, Y., van Heere, B., Everett, B., & Davidson, P. (2006). Voices from the floor: nurses’ perceptions of the medical emergency team. Intensive and Critical Care Nursing, 22, 138-143. doi: 10.1016/j.iccn.2005.10.002

4. Massey D, Aitken LM, Chaboyer W (2010). Literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient? Journal of Clinical Nursing, 19, 3260–3273 doi: 10.1111/j.1365-2702.2010.03394.x