Article, 2024
Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
Critical Care Medicine,
ISSN
1530-0293,
0090-3493,
Volume 52,
2,
Pages 314-330,
10.1097/ccm.0000000000006072
Contributors
Honarmand, Kimia
0000-0002-7583-1445
[1]
[2]
Wax, Randy Stuart
0000-0001-9084-8264
[3]
[4]
Penoyer, Daleen Aragon
[5]
Lighthall, Geoffery
[6]
[7]
[8]
Danesh, Valerie C
0000-0002-2078-2578
[9]
Rochwerg, Bram Noah
0000-0002-8293-7061
[1]
[2]
Cheatham, Michael Lee
[10]
Davis, Daniel P
[11]
Devita, Michael A
[12]
[13]
Downar, James
[14]
Edelson, Dana Peres
[15]
Fox-Robichaud, Alison Elizabeth
0000-0001-9912-3606
[2]
Fujitani, Shigeki
[16]
Fuller, Raeann M
[17]
Haskell, Helen
[18]
Inada-Kim, Matthew
0000-0001-6026-2246
[19]
Jones, Daryl
[20]
Kumar, Anand
[21]
Olsen, Keith M
[22]
Rowley, Daniel D
[23]
Welch, John Robert
0000-0001-9172-3869
[24]
Baldisseri, Marie R
[25]
Kellett, John
[26]
Knowles, Heidi C
[27]
Shipley, Jonathan K
[28]
Kolb, Philipp
[2]
[29]
Wax, Sophie P
[4]
Hecht, Jonathan D
[30]
Sebat, Frank
(Corresponding author)
[31]
Affiliations
- [1]
Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, ON, Canada.
[NORA names:
Canada; America, North; OECD];
- [2]
McMaster University
[NORA names:
Canada; America, North; OECD];
- [3]
Lakeridge Health
[NORA names:
Canada; America, North; OECD];
- [4]
Queen's University
[NORA names:
Canada; America, North; OECD];
- [5]
Orlando Health
[NORA names:
United States; America, North; OECD];
(... more)
- [6]
Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, CA.
[NORA names:
Spain; Europe, EU; OECD];
- [7]
Stanford University
[NORA names:
United States; America, North; OECD];
- [8]
Veterans Affairs Medical Center, Palo Alto, CA.
[NORA names:
United States; America, North; OECD];
- [9]
Baylor Scott & White Health
[NORA names:
United States; America, North; OECD];
- [10]
Orlando Regional Medical Center
[NORA names:
United States; America, North; OECD];
- [11]
Emergency Medical Services, Logan Health, Kalispell, MT.
[NORA names:
United States; America, North; OECD];
- [12]
Columbia University
[NORA names:
United States; America, North; OECD];
- [13]
Harlem Hospital Center
[NORA names:
United States; America, North; OECD];
- [14]
University Health Network
[NORA names:
Canada; America, North; OECD];
- [15]
University of Chicago Medical Center
[NORA names:
United States; America, North; OECD];
- [16]
Division of Critical Care, Department of Emergency Medicine, Saint Marianna University, Kawasaki, Japan.
[NORA names:
Japan; Asia, East; OECD];
- [17]
Division of Trauma and Critical Care, Department of Emergency Medicine, Advocate Condell Medical Center, Libertyville, IL.
[NORA names:
United States; America, North; OECD];
- [18]
Mothers Against Medical Error, Columbia, SC.
[NORA names:
United States; America, North; OECD];
- [19]
University of Southampton
[NORA names:
United Kingdom; Europe, Non-EU; OECD];
- [20]
University of Melbourne
[NORA names:
Australia; Oceania; OECD];
- [21]
University of Manitoba
[NORA names:
Canada; America, North; OECD];
- [22]
Nebraska Medical Center
[NORA names:
United States; America, North; OECD];
- [23]
University of Virginia Medical Center
[NORA names:
United States; America, North; OECD];
- [24]
University College London Hospitals NHS Foundation Trust
[NORA names:
United Kingdom; Europe, Non-EU; OECD];
- [25]
University of Pittsburgh Medical Center
[NORA names:
United States; America, North; OECD];
- [26]
University of Southern Denmark
[NORA names:
SDU University of Southern Denmark;
University; Denmark; Europe, EU; Nordic; OECD];
- [27]
JPS Health Network
[NORA names:
United States; America, North; OECD];
- [28]
Vanderbilt University Medical Center
[NORA names:
United States; America, North; OECD];
- [29]
Dalhousie University
[NORA names:
Canada; America, North; OECD];
- [30]
The University of Texas at Austin
[NORA names:
United States; America, North; OECD];
- [31]
Mercy Medical Center
[NORA names:
United States; America, North; OECD]
(less)
Abstract
RATIONALE: Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care hospitals have implemented systems aimed at detecting and responding to such patients.
OBJECTIVES: To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.
PANEL DESIGN: The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines.
METHODS: We generated actionable questions using the Population, Intervention, Control, and Outcomes (PICO) format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation Approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).
RESULTS: The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among unselected patients. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system.
CONCLUSIONS: The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.
Keywords
Critical Care Medicine guidelines,
GPS,
ICU,
Medicine guidelines,
Palliative Care members,
Recommendations Assessment,
Society of Critical Care Medicine guidelines,
acquisition,
activation criteria,
activity,
acute care hospitals,
administration,
approach,
assessment,
at-risk,
bedside,
bedside clinicians,
care,
care hospital,
care members,
certainty,
clinic,
clinical deterioration,
clinical deterioration of patients,
clinical practice guidelines,
clinicians,
composition,
concerns,
conditional recommendation,
continuous vital sign monitoring,
control,
criteria,
critical illness,
decision,
deployment,
deterioration,
deterioration of patients,
development,
education,
effective process,
emergency team,
evaluation,
evaluation approach,
evidence,
evidence-based clinical practice guidelines,
evidence-based recommendations,
expertise,
focused education,
goals of care,
grade,
guidelines,
healthcare,
healthcare personnel,
hospital,
hospital clinicians,
illness,
improvement process,
inclusion,
institutions,
intervention,
literature,
medical emergency team,
medicine,
members,
monitoring,
morbidity,
mortality,
non-ICU patients,
nurses,
opinion,
optimal recognition,
outcomes,
panel,
partners,
partners' concerns,
patient goals,
patient's goals of care,
patient/family,
patients,
patients at-risk,
personnel,
pharmacy,
population,
practice guidelines,
process,
professional composition,
quality,
quality improvement process,
questions,
recognition,
recognizer,
recommendations,
representatives,
respiratory therapy,
respondents,
responder teams,
response,
response system,
response team,
response to clinical deterioration,
reverse morbidity,
review,
sign acquisition,
skills,
society,
source,
statements,
system,
systematic review,
team,
therapy,
vital sign acquisition,
vital sign monitoring
Funders
Data Provider: Digital Science