Medical emergency teams and rapid response triggers - the ongoing quest for the 'perfect' patient safety system
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* Corresponding author: Philip F Stahel philip.stahel@dhha.org
1 Department of Orthopaedic Surgery, and Department of Neurosurgery, Denver Health Medical Center, University of Colorado Denver, School of Medicine, Bannock Street, Denver, CO 80204, USA
2 Department of Patient Safety and Quality, and Department of Internal Medicine, Denver Health Medical Center, University of Colorado Denver, School of Medicine, Bannock Street, Denver, Denver, CO 80204, USA
Critical Care 2009, 13:420 doi:10.1186/cc8052
The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/13/5/420
| Published: | 9 October 2009 |
© 2009 BioMed Central Ltd
Letter
We read with interest the article by Iyengar and colleagues [1] on the impact of standardized implementation of medical emergency teams (METs) for the early identification and management of acutely deteriorating patients on the ward. The vast majority (88%) of all preventable adverse events were classified as 'therapeutic errors'. The authors have to be commended for their proactive patient safety approach by implementation of a standardized method for root cause analysis and classification of preventable adverse events.
We and others have recently proposed an alternative model to the MET, namely one based on defined clinical triggers to initiate a rapid response escalation [2-4]. A clinical triggers system overcomes the 'classic' limitations of the MET system, as related to an overuse of resources and the fragmentation of patient care. The clinical triggers program established at Denver Health Medical Center involves a standardized 'afferent' limb of patient identification based on objective, physiological response triggers for a rapid response escalation. The 'efferent' limb is provided by the designated primary house staff team caring for the individual patient [2,3].
While the present study [1] was not designed to address issues related to response system modalities, the root cause analysis by Iyengar and colleagues supports the rationale of a clinical triggers-based response system. As such, the therapeutic errors identified as the major determinant of preventable adverse events [1] are likely recognized and corrected in a more accurate and timely fashion by a team of providers associated with the continuum of care, as opposed to a MET, which involves people who are unfamiliar with patients' pertinent medical conditions. These aspects should be taken into consideration in the ongoing debate and controversy about safety and efficiency of the 'perfect' rapid response system [5].
Abbreviations
MET: medical emergency team.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
Both authors contributed equally to the design and writing of this letter.
References
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Iyengar A, Baxter A, Forster AJ: Using Medical Emergency Teams to detect preventable adverse events.
Crit Care 2009, 13:R126. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text
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Moldenhauer K, Sabel A, Chu ES, Mehler PS: Clinical triggers: an alternative to a rapid response team.
Jt Comm J Qual Patient Saf. 2009, 35:164-174. PubMed Abstract | Publisher Full Text
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Stahel PF, Smith WR, Clarke TJ, Mehler PS: [Patient safety in surgery: what lessons can we learn from the current US-standards?].
Periop Med 2009, 1:34-43. Publisher Full Text
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Cherry K, Martinek J, Esleck S, Ivory A, Logan R, Ward J: Developing and evaluating a trigger response system.
Jt Comm J Qual Patient Saf. 2009, 35:331-338. PubMed Abstract | Publisher Full Text
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Sirio CA: Clinical triggers or rapid response teams: does the emperor need "new" clothes?
Jt Comm J Qual Patient Saf. 2009, 35:162-163. PubMed Abstract | Publisher Full Text