Rapid Response Teams No Substitute for Wrong Bed Assignment

Cheryl Clark, September 23, 2010

Giving hospital "rapid response" teams credit for saving lives of suddenly deteriorating inpatients is "like rewarding a pilot for ultimately landing safely after he or she had made a dangerous decision to take off during inclement weather," two prominent patient safety leaders claim.

Rather, hospitals and physicians should make sure the patients aren't assigned to units providing an inadequate level of care in the first place, wrote Peter Pronovost, MD, a Johns Hopkins University intensivist, and Eugene Litvak, president of the Institute for Healthcare Optimization in Newton, MA.

"It's a silly science when you take credit for your own bad decisions," Pronovost said in a statement.

In a somewhat harsh commentary in the Journal of the American Medical Association, Pronovost and Litvak spelled out the disastrous cascade that results when patients who are mistakenly assigned beds outside the intensive care unit suddenly get much worse and teeter toward death.

They acknowledged that some patients deteriorate despite being assigned to an adequate level of care, and may benefit from an organized system to identify and treat patients who get quickly worse.

But far too many other patients need rescue because they were simply assigned to the wrong level of care at the start, or reassigned, because beds providing the right level they need—an intensive care unit or monitored unit —were all filled up or there was an error in triage.

"Intensive care units and monitored beds are scare resources, demand for these resources periodically exceeds supply, and patients are often not admitted to these preferred units," they wrote.

The authors, in part, blame poor timing in the use of hospital services, such as elective surgical suites during prime emergency room days, Tuesday, Wednesday and Thursday. On those days, surges occur, although they are largely unpredictable.

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