Evaluating pre-rapid response team clinical escalations using a bidirectional messaging system in a tertiary hospital.

BACKGROUND

Pre-rapid response team (pre-RRT) systems are designed to facilitate early recognition and management of deteriorating hospitalised patients. In 2022, our institution implemented a novel role-based asynchronous messaging platform to support urgent clinical review (UCR) activations.

OBJECTIVES

To describes the frequency, timing, nature, and appropriateness of UCR activations and evaluates utilisation of the communication platform.

METHODS

A retrospective observational study was conducted including all UCR messages sent via a role-based communication system at a tertiary Australian hospital between January and June 2024. Message metadata were analysed to describe activity patterns and response times. A systematic sample of every fifth UCR message underwent detailed review to assess appropriateness and reasons for escalation.

RESULTS

During the six-month study period, 27 401 UCR messages were sent, representing a median of 182 (interquartile range: 164-201) activations per day. Activations demonstrated marked diurnal variation, peaking during nursing handover and routine observation periods. Median time to first written response was 9 min (interquartile range: 2-26). Detailed review of 5524 messages found that 99.6% were sent by nursing staff and 98.6% were directed to medical teams. Most reviewed messages (96.6%) were appropriate UCR-related communications, while only 3.4% were unrelated to the escalation process. Tachycardia (22.3%), hypotension (14.4%), and tachypnoea (12.2%) were the most common physiological triggers. Clinical concerns including uncontrolled pain, possible cardiac ischaemia, and bleeding were also frequent reasons for escalation.

CONCLUSIONS

Pre-RRT activations represent a substantial component of hospital clinical workload, with approximately 1000 UCR events occurring each week. A role-based asynchronous messaging platform enabled granular communication, an average medical response time of between 9 and 14 min, and was used appropriately in the vast majority of cases. These findings provide insights into the operational burden of pre-RRT systems and may inform future strategies to optimise escalation pathways, clinician workload, and patient safety.