Bedside nurse reason for rapid response activation versus rapid response nurse determination of criteria met: Is there concordance?

Background: Nearly 100% of hospitalized adults are managed at some point in their hospital course on general medical/surgical wards. Recognition and treatment of early clinical deterioration in these patients is often delayed, leading to an increase in morbidity and mortality. In a previous study, a four-component Rapid Response System (RRS) was developed with a significant focus on training the bedside staff with expanded activation criteria to facilitate earlier recognition and rapid treatment of shock patients. A similar system was implemented at the study hospital in 2010. Methods: Expanded vital sign assessment (10 Signs of Vitality [10 SOV]) (temperature, heart rate [HR], respiration rate [RR], systolic blood pressure [SBP], pain, O2 saturations [SpO2], altered level of consciousness [ALOC], capillary refill, urine output [UO], and lactic acid [LA]/base deficit [BD]) were utilized to assess patients on all medical/surgical floors. Two of the weighted criteria -- RR < 6 or RR > 20, SpO2 < 90%, SBP <90, ALOC, capillary refill > 3 seconds, UO < 100 mL/4hr, and one of the following: temperature < 36C, LA > 2.0 mmol/L, or BD > 5 mmol/L -- should be met in order to activate the RRS. However, the bedside nurse is also encouraged to activate the RRS if there is concern for the patient even if two of the seven criteria are not met. Continuous variables were analyzed using paired sample t-test and categorical variables were analyzed using McNemar's test. Results: Preliminary results indicate that patients meet additional RRS criteria aside from the reason(s) for the call. There were 303 unique patients resulting in 359 RRS cases. Cases had significantly more abnormal vital signs when determined by RRS nurse compared to bedside nurse (t(358)=7.416, p<0.0001). Despite this, there was no significant difference in a case meeting at least two of seven weighted criteria as determined by RRS nurse compared to bedside nurse (p=0.188) although there were several different significances observed across specific criteria (hypothermia: p=0.011; hyperthermia: p<0.0001; pain: p<0.0001; RR: p<0.0001; SpO2: p<0.0001; SBP: p<0.0001; and LA/BD: p<0.0001). No significant differences were observed for HR (p=0.200), ALOC (p=0.321), capillary refill (p=0.458), and UO (p=0.824). Conclusions: The 10 SOV is a useful tool to assist in identifying patients at risk for continued deterioration. When a bedside nurse activates the RRS the patient frequently meets objective criteria and is in need of rapid re-assessment and mobilization of resources.