Rapid response systems : evaluation of program context, mechanism, and outcome factors

ii No one, prophet, intellectual or evaluator, can claim to be in possession of the universal standpoint, that secret scientific key to truth. Ray Pawson & Nick Tilley Realistic Evaluation iii ACKNOWLEDGMENTS During my doctoral studies I have received inspiration, encouragement, and support from many people. I would not have begun this journey without the love, support and patience of my family and friends. Thank you for believing in me. The University of Iowa College of Nursing faculty challenged me to expand my thinking. I have learned more than I believed was possible. Thank you. A doctoral journey is not completed in isolation. My peers and colleagues in the PhD program have been there every step of the way. Thank you for your friendship, laughter, and insights. My dissertation committee has graciously shared their wisdom and guided me through the most challenging stages of the PhD program. Thank you for helping me to grow as a scholar. Finally, thank you to the hospital leadership, Rapid Response team members, and staff nurses for sharing their quality improvement data and providing excellent patient care every single day. iv ABSTRACT Prevention of in-hospital cardiac arrest (IHCA) is critical to reducing morbidity and mortality as both the rates of return to pre-hospital functional status and overall survival after IHCAs are low. Early identification of patients at risk and prompt clinical intervention are vital patient safety strategies to reduce IHCA. One widespread strategy is the Rapid Response System (RRS), which incorporates early risk identification, expert consultation, and key clinical interventions to bedside nurses caring for patients in clinical deterioration. However, evidence of RRS effectiveness has been equivocal in the patient safety literature. This study utilized a holistic Realistic Evaluation (RE) framework to identify important clinical environment (context) and system triggers (mechanisms) to refine our understanding of an RRS to improve local patient outcomes and develop a foundation for building the next level of evidence within RE research. The specific aims of the study are to describe a RRS through context, mechanism, and outcome variables; explore differences in RRS outcomes between medical and surgical settings, and identify relationships between RRS context and mechanism variables for patient outcomes. Study RRS data was collected retrospectively from a 397-bed community hospital in the Midwest; including all adult inpatient RRS events from May 2006 (2 weeks post-RRS implementation) through November 2013. RRS events were analyzed through descriptive, comparative, and proportional …