Peter Hicks on Do we need a RRT registry? Presented at the ANZICS S&Q Conference 2014 on Rapid Response Teams.

1. Rapid Response Team
Registry
Peter Hicks
ICU Specialist – Wellington
Director ANZICS CORE

2. Are we doing this right

3. Rapid Response Teams
• Are we doing this right?
• Are we doing this well?
• Are we doing this safely
• Are we doing this efficiently
• Can we do it better

4. What is a (Clinical) Registry
• Collections of information
• (databases)
• Reports
• Processes
• Research
• A registry is a quality activity

5. • ANZICS CORE
• ANZ Dialysis and Transplant Registry
• Cardiothoracic Surgical Registry
• Major Trauma
• Massive Transfusion
• Cancer
• Haemophilia
• etc

6. Steps
• Identify the patient/process/disease
• Collect information
• Send it somewhere
_______________
• Clean/correct the data
• Write the reports and distribute
• Review the reports centrally
_________________
• Review the reports locally

7. • Adult Patient Database
110,000+ submissions per year
Outcomes, illness severity, diagnosis
• Critical Care Resources Registry
Annual survey – 167 hospitals
Beds, Staffing, Resources
• ANZ Paediatric Intensive Care Registry
8000+ submissions per year
440 + Routine reports
64 Data requests
13 Publications
3 Reports
ANZICS
Adult
Patient
Database
AUDIT
ANZICS Centre for Outcome and Resource Evaluation

8. ANZICS CORE
• Compare units against a standard
• Compare units against other units
• Mortality rates and ratios
• After hours discharges
• Cancelled surgery
• Readmissions
• Resources (beds, staffing)
• Use of DVT prophylaxis
• CLABSI rates

9. • Reports
• For individual units
• With other units unnamed
• For state health departments
• (Bi)-National summaries
• Governance:
• What do we do if we find a unit that
might be under performing?

11. RRT Assessment
• Structure
• Function
• Outcome

12. RRT Registry
• Structure:
• How is your RRT setup
• Who is in it
• Where does it live
• Who pays.
• What Early Warning Score system
• What is the activation level
• What is the response system

13. RRT Registry
• Functioning:
• How many calls (indexed to your
hospital size/activity) dose?
• What sort of calls (Arrests or not)
• What sort of patients (DNAR)
• What time of day
• Were the patient’s obs done
• Was an EWS calculated everytime

14. RRT Registry
• Outcome
• Did the activation/response work
properly
• What was the outcome of that call for
the patient.
• What happened to the patient later
• What is your hospital mortality rate
• What effect does the RRT have

15. RRT Difficulties
• RRT event generally easy to identify
• But existing IT systems don’t help
• Most data needs to collected at the
time of the event
• Existing IT systems don’t help
• May be lots of data
• Structuring the events
• multiple RRT calls
• Related or unrelated calls

16. RRT Difficulties
• Not all RR Teams, EWS or
Activation/Responses are the same
• Can make comparisons hard
• How do we benchmark
• Outcomes
• Rates of use depend of your criteria
• Death may not be a good outcome
measure.
• How you die may be.

17. RRT Difficulties
• Governance:
• RRT not “owned” by any professional
group.
• Who will manage the outliers and
problems.
• Who will provide “confidence”

18. Expensive
• ANZICS CORE
• Employs 8 people
• Costs $1 million per year
• Subsidised by ANZICS
• Provides “free” software
• 120-160 contributing units
• Paid and unpaid data collectors

19. Research Questions
• Ideal Early Warning Score
components and values
• Ideal activation threshhold
• Ideal response system
• Ideal “dose” of RRT calls
• Ideal quality measures.
• Does RRT do harm for some
patients?
?
?

20. Summary
• Registry will measure/monitor
quality.
• Data maybe hard to collect
• Systems not the same
• Some structure design issues
• Quality measures unclear.
• Expensive and time consuming
• Its absolutely necessary

21. “Rapid Response”
Thank You