ReviewCritical care research and practice2019
Performance of the Afferent Limb of Rapid Response Systems in Managing Deteriorating Patients: A Systematic Review.
Review in Critical care research and practice, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Clinical Effectiveness of AI-Based Cardiac Arrest Prediction System for General Ward Patients (VITAL-MD): Protocol for a Multicenter Pragmatic Stepped Wedge Cluster Randomized Controlled Trial.JMIR research protocols · 2026Article
- Parent's Process of Escalation of Care for Their Deteriorating Children Admitted to Paediatric Wards: A Grounded Theory.Journal of clinical nursing · 2026Article
- Clinical Effectiveness of an Artificial Intelligence-Based Prediction Model for Cardiac Arrest in General Ward-Admitted Patients: A Non-Randomized Controlled Trial.Diagnostics (Basel, Switzerland) · 2026Article
- Relationship between Time of Day of Medical Emergency Team Activations and Outcomes of Hospitalized Pediatric Patients.Journal of pediatric intensive care · 2024Article
- Variation in nurses' compliance with an Early Warning Score protocol: A retrospective cohort study.Heliyon · 2024Article
- Article
- Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit.Journal of hospital medicine · 2023Article
- Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: a qualitative study.BMJ open quality · 2023Article
- Clinical impact of vital sign abnormalities in patients admitted with acute exacerbation of chronic obstructive pulmonary disease: an observational study using continuous wireless monitoring.Internal and emergency medicine · 2022Observational
- The transcultural adaptation and validation of the Chinese version of the Attitudes Toward Recognizing Early and Noticeable Deterioration scale.Frontiers in psychology · 2022Article
- Increased time from physiological derangement to critical care admission associates with mortality.Critical care (London, England) · 2021Article
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe clinical components of the rapid response system (RRS) are the afferent limb, to ensure identification of in-hospital patients who deteriorate and activation of a response, and the efferent limb, to provide the response. This review aims to evaluate the factors that influence the performance of the afferent limb in managing deteriorating ward patients and their effects on patient outcomes.
methodsA systematic review was performed for the years 1995-2017 by employing five electronic databases. Articles were included assessing the ability of the ward staffs to monitor, recognize, and escalate care to patient deterioration. The findings were summarized using a narrative approach.
resultsThirty-one studies met the inclusion criteria. The analysis revealed major themes enclosing several factors affecting management of patients having sudden deterioration. The monitoring and recognition process was conditioned by the lack of recording of physiological parameters, the influence of facilitators, including staff education and training, and barriers, including human and environmental factors, and poor compliance with the calling criteria. The escalation of care process highlighted the influence of cultural barriers and personal judgment on RRS activation. Mainly, delayed team calls were factors strongly associated with the increased risk of unplanned admissions to the intensive care unit and length of stay, hospital length of stay and mortality, and 30-day mortality.
conclusionsA combination of factors affects the timely identification and response to sudden deterioration by general ward staffs, leading to suboptimal care of patients, delayed or failed activation of RRS teams, and increased risks of worsening outcomes. The research efforts and clinical involvement to improve the governance of the factors limiting the performance of the afferent limb may ensure proper management of hospitalized patients showing physiological deterioration.
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