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Expanding the scope of Critical Care Rapid Response Teams: a feasible approach to identify adverse events. A prospective observational cohort
  1. Andre Carlos Kajdacsy-Balla Amaral1,
  2. Andrew McDonald2,
  3. Natalie G Coburn3,
  4. Wei Xiong4,
  5. Kaveh G Shojania5,
  6. Robert A Fowler1,
  7. Martin Chapman1,
  8. Neill K J Adhikari1
  1. 1Interdepartmental Division of Critical Care, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  3. 3Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  4. 4Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Andre Carlos Kajdacsy-Balla Amaral, Interdepartmental Division of Critical Care, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Office D1 08, Toronto, ON, Canada M4N 3M5; AndreCarlos.Amaral{at}


Introduction Adverse events (AEs) affect 3–12% of hospitalised patients. These are estimates from a labour-intensive chart review process,which is not feasible outside research. Clinical deterioration on the wards triggers a rapid response teams (RRTs) consult and can be used to identify an AE prospectively.

Objectives To demonstrate the feasibility of using RRT to detect AEs and compare this methodology to the rates reported using an electronic safety reporting system.

Methods Prospective observational cohort of RRT consults. Three independent physicians reviewed all cases for the occurrence of an AE and its preventability. We summarise AEs as rates per 1000 patient-days, and compared the rates between RRT and the safety reporting system using a Poisson model.

Results There were 8713 hospital admissions, with 531 RRT consults and 247 (2.8%) cases included. Forty-four (17.8%) and 35 cases (14.2%) were judged as AEs and preventable AEs, respectively. RRT identified 0.52 AE/1000 patient-days, compared with 0.21 AE/1000 patient-days detected through the electronic safety reporting system (rate ratio 2.4, 95% CI 1.4 to 4.2, p=0.0014). Patients in surgical wards had more AEs (0.83/1000 vs 0.36/1000, p<0.01) and preventable AEs (0.70 vs 0.21, p<0.01) than patients in medical wards. Agreement for AE (κ 0.46, 95% CI 0.39 to 0.53) and preventable AE (κ 0.47, 95% CI 0.40 to 0.53) was moderate among reviewers.

Conclusions Reviewing RRT consults identified a high proportion of AEs and preventable AEs. This methodology detected twice as many AEs as the hospital's safety reporting system. RRT clinicians provide a complementary and more sensitive mechanism than traditional safety reporting systems to identify possible AEs in hospitals.

  • Chart review methodologies
  • Adverse events, epidemiology and detection
  • Medical emergency team
  • Human error
  • Incident reporting

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