• Christian P Subbe, Jonathan Bannard-Smith, Jacinda Bunch, Ratapum Champunot, Michael A DeVita, Lesley Durham, Dana P Edelson, Isabel Gonzalez, Christopher Hancock, Rashan Haniffa, Jillian Hartin, Helen Haskell, Helen Hogan, Darly A Jones, Cor J Kalkman, Geoffrey K Lighthall, James Malycha, Melody Z Ni, Alison V Phillips, Francesca Rubulotta, Ralph K So, John Welch, and International Society for Rapid Response Systems.
• School of Medical Sciences, Bangor University, Wales, UK. Electronic address: csubbe@hotmail.com.
• Resuscitation. 2019 Aug 1; 141: 1-12.

BackgroundClinically significant deterioration of patients admitted to general wards is a recognized complication of hospital care. Rapid Response Systems (RRS) aim to reduce the number of avoidable adverse events. The authors aimed to develop a core quality metric for the evaluation of RRS.MethodsWe conducted an international consensus process. Participants included patients, carers, clinicians, research scientists, and members of the International Society for Rapid Response Systems with representatives from Europe, Australia, Africa, Asia and the US. Scoping reviews of the literature identified potential metrics. We used a modified Delphi methodology to arrive at a list of candidate indicators that were reviewed for feasibility and applicability across a broad range of healthcare systems including low and middle-income countries. The writing group refined recommendations and further characterized measurement tools.ResultsConsensus emerged that core outcomes for reporting for quality improvement should include ten metrics related to structure, process and outcome for RRS with outcomes following the domains of the quadruple aim. The conference recommended that hospitals should collect data on cardiac arrests and their potential predictability, timeliness of escalation, critical care interventions and presence of written treatment goals for patients remaining on general wards. Unit level reporting should include the presence of patient activated rapid response and metrics of organizational culture. We suggest two exploratory cost metrics to underpin urgently needed research in this area.ConclusionA consensus process was used to develop ten metrics for better understanding the course and care of deteriorating ward patients. Others are proposed for further development.Copyright © 2019 Elsevier B.V. All rights reserved.

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