8/23/2019

Rapid Response
System
Anna Seleska
Emergency Physician
RS Hermina Yogya

dr Anna Seleska
SpEm
Emergency Physician
Emergency Residency Programme
Brawijaya University
2014 – 2017
anna.seleska@gmail.com

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Rutherford P, Lee B, Greiner A. Transforming Healthcare at the Bedside. IHI Innovation Series White paper. Boston:Institute for Healthcare
Improvement. 2004

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If you put good people in bad systems, you

get bad results.
You have to water the flowers you want to
grow
Stephen Covey

Apakah pasien aman dirawat di

Rumah Sakit Hermina?

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European society of Cardiology. 2015

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Jones et al, 2011. Rapid Response Teams. NEJM

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RESPON TIME : 10 menit RESPON TIME : 5 menit

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WHY are we here?

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The hospital system of care must prioritize patient safety and

view errors as a problem with the system, instead of an
individual error
DeVita et al, 2006
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WHAT is RSS?
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Entire System for responding to all patients with a critical

medical problem
OR
Systems that seek to prevent deterioration and arrests
rather than respond to arrests.

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NEW GOAL

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RRS
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Improve the quality of patient care by reducing AVOIDABLE

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morbidity and mortality

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OUR VISION
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Create system that

improve recognition
and response to
changes in a
patient’s condition
 SAFE HOSPITAL

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RATIONALE for approach in

handling patient crisis

THERE IS TIME FOR INTERVENTION

the evolution of clinical and physiological

deterioration is relatively slow

THERE ARE WARNING SIGNS

Clinical deterioration is preceded by
physiological deterioration in commonly
measured vital signs

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THERE ARE EFFECTIVE TREATMENT

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If dangerous condition are recognized

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RATIONALE in approach for
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handling patient crisis

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ANY MEMBER OF STAFF CAN ACTIVATE THE MET

Hassle free and less hierarchy in response
team

EARLY INTERVENTION IMPROVES OUTCOME

It is intuitive that sick people are easier to
treat than dead people
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THE EXPERTISE EXIST AND CAN BE

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DEPLOYED
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Ithe review of the critically ill patient is

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What’s so different with MET

(source : General Principles of Medical Emergency
Team. Jones et al, 2006)

Rapid Response System’s Structure

(source : Provost et al, 2016)

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Afferent Limb’s steps

Components : TRIGGERING CRITERIA
HUMAN/TOOLS MONITORING
MECHANISM FOR TRIGGERING RESPONSE
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OUR HOSPITAL CAPACITY

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CURRENT SYSTEM

SUPPORT
AVERAGE TOTAL BED
FROM
MANAGERIAL
LINE
BARRIERS
NUMBER IN
NURSES & IMPLEMENTATIO
DOCTORS N
RESPONSE TIME FOR RRT/MET
COMMUNICATION CULTURE
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Think again and

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Understanding hospital capacity is necessary before

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implementing RSS
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field
Identification of Problems in the

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PROPOSE SYSTEM for HHG
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WHICH WAY?

Availability Tailored made

Accesibility According to average
Ability hospital capacity

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Implementing the Outreach tream 

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system through EWS

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HOW MANY
PERSONNEL?

MET Outreach Team

1 doctor 1 nurse 1-2 ICU/ER skilled
OR nurse
2 nurse
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There is no perfect system

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When vital signs
are abnormal, When vital signs are
there may be no measured,they are
specific criteria for sometimes incomplete
Individual judgment
activating a vary and is applied
higher-level to a crucial decision
Monitoring
intervention
tech is used in
If an alert is issued,
FAILURE TO
Intensive unit
the activation
Regular visit
by nurse vary
process goes
through a long
RESCUE
Hospital-ward
in frequency chain of command
monitoring is
and duration and associated
only
with delays and
intermittent
individual
(vital sign) Treating complex judgement
cases but doctor
and nurse are
busy with other
tasks
Jones et al, 2011. Rapid Response Teams. NEJM

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SNARS 2017 PAP 3.2

SNARS 2017 PAP 3.1
Standar PAP 3.2
Staf mampu mengidentifikasi kejadian Pelayanan resusitasi tersedia di area
pasien memburuk sedini dininya dan bila rumah sakit
perlu mencari bantuan staf yang kompeten. Elemen penilaian
Salah satu metode untuk deteksi dini 1.Ada regulasi (standar alat, obat
kegawatan adalah dengan sistem skoring dan staff (termasuk pediatrik)
2.BHD segera dan Bantuan hidup
Elemen penilaian: lanjut < 5 menit
1.Ada regulasi EWS 3.Pelatihan pelayanan resusitasi
2.Ada bukti staf dilatih EWS
3.Ada bukti pelaksanaan EWS
4.Tersedia pencatatan EWS
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Track &
Trigger
System
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