Introducing rapid response teams in Slovenia

Introduction

Hospitals in Slovenia lack an organized approach to medical emergencies and clinical deterioration in hospitalized patients. The Institute of Oncology (IO) is the first hospital in Slovenia that is considering implementation of rapid response teams (RRT) with the intention of improving patient safety and care. The IO is a teaching hospital and tertiary national cancer centre for Slovenia. On average, 350 outpatients and 210 inpatients are treated every day.

Methods

A cross-sectional study of emergencies and clinical deteriorations in our wards from August to October 2007 with intent to access the situation and provide the optimal basis for introduction of RRT. Data were collected through a report form that was filled out by doctors and nurses on the ward at the time of the emergency or clinical deterioration. All hospital wards were included.

Results

A total of 3,140 patients were hospitalized during this 3-month period and 43 reports were returned. Most emergencies and clinical deteriorations were linked to active patient treatment – surgical and systemic therapy (chemotherapy and target therapies). The most common complications were: sepsis (34.8%), serious hypersensitivity to therapy (30.2%), pulmonary embolism (9.3%), bleeding (4.6%), followed by single cases of ileus, acute respiratory failure, cardiac arrest, spinal cord compression, stroke, pneumothorax, high intracranial pressure, peritonitis, and acute renal failure. There were seven fatal outcomes (16.3%), all transferred and treated in the ICU, caused mainly by late identification and treatment of sepsis, and were possibly preventable.

Conclusion

The incidence of emergencies and clinical deteriorations in the IO was somewhat lower than reported, which can be ascribed to under-reporting [1]. The results are useful for providing basis for planning the most efficient and appropriate form of RRT but also to provide better education for ward staff with the intent to improve their awareness and immediate management of these conditions. As a result we hope to introduce RRT by the end of 2008, as the first hospital in Slovenia. We intend to continue with assessment of emergencies on the wards also as a part of quality assessment after the introduction of RRT.