Medical Emergency Team (MET)/Crash Team
A medical emergency team (MET) or ‘Crash Team’ can be contacted on 2222 in an emergency in an acute hospital in the United Kingdom. This team comprises selected on‐call clinicians normally from the on‐call medical team, intensive care teams and critical care outreach teams who respond when called to a medical emergency. The Crash Team is also summoned by calling 2222 and is normally the same clinicians from the MET, although other staff such as resuscitation officers and anaesthetists may also respond to a crash call.
999 Emergency Services
In patient homes, GP surgeries, community hospitals and other community settings, the most appropriate response to a deteriorating patient is the ambulance service; within the United Kingdom, an emergency ambulance is arranged by calling 999.
The first person you speak to will be an operator who will ask you which emergency service you require and will connect you to the ambulance service when asked to. The next person you speak to will be an ambulance service call taker who is not a healthcare professional; therefore, it is important to give clear information about the patient, and this will enable them to complete a triage pathway and arrange the most appropriate response.
They will ask you a set of questions from a protocol which you must answer, even if they seem inappropriate, given your professional role. On arrival of the ambulance, you will normally handover to a clinician such as a paramedic, emergency care practitioner, ambulance technician or registered nurse all of whom have expertise in the management of unwell patients.
Violet Flag
In acute and community inpatient hospitals in the United Kingdom, the use of the National Early Warning Score (NEWS) is now embedded into policies regarding identifying and escalating concerns about patient’s clinical observations, with a scoring system used to identify who should be contacted to provide further assessment of the patient. NEWS is discussed later in the chapter.
Challenges of Communication
Patient safety is a key priority in patient care, and communication errors are the most common cause of adverse events during episodes of patient care. Nursing associates and other healthcare providers endeavour to avoid communication errors during patient handover. SBAR and RSVP communication tools can reduce adverse events in a hospital setting.
Loss of information in verbal handover between different staff groups is known to be a contributing factor in clinical incidents (Rabøl et al. 2011; Müller et al. 2018), and consequently, the development and use of escalation tools allow us to reduce the chance of error by utilising a standardised approach across all professions.
Poor communication is identified as being a factor in 35% of hospital complaints; noted particularly is the quality and accuracy of the information (Ford 2015). The quality and accuracy of information is very much determined by the person escalating concerns; therefore, utilising the earlier suggestions to prepare the handover beforehand and utilising a ‘template form’ or SBAR stickers (often required by some National Health Service (NHS) Trusts) can help increase the likelihood of good communication.
Delayed communication of escalation concerns has previously been a concern and is regarded as being just as serious as other failures of communication (Taran 2011). The development of the NEWS system indicates where patient observations are abnormal and prompts the need to escalate concerns; however, the clinical judgement remains paramount in regards to timely escalation and prioritising it above other conflicting care activities.
Touch Point
The NEWS was introduced around 2007, in recognition of episodes of failed care where healthcare professionals had not recognised or failed to escalate patient deterioration, or did not escalate appropriately.
The NEWS attributes point to each observation taken and collectively gives an indication of the patient’s deterioration. The total score then identifies the type and route of escalation required (National Patient Safety Agency 2007). This is often embedded and adapted to fit with the hospital’s policy and available staff and teams to escalate to.
It is important to remember that this a ‘safety net’ tool. It is not necessary to wait for a ‘trigger’ to escalate when concern about a patient is justified by assessment and clinical decision‐making.
NEWS is becoming more popular outside of hospital environments, with adaptations starting to arise in nursing homes, GP surgeries and ambulance services. The evidence‐base underpinning NEWS was developed in and for inpatient hospitals; therefore, further research is required to build evidence‐base in using NEWS outside of a hospital environment.
Supporting Evidence
The following references supported the fundamental changes to the NHS approach to deteriorating patient care:
National Institute for Health and Care Excellence (2007) Acutely Ill Adults: Recognising and Responding to Deterioration. National Institute for Health and Care Excellence, London.
National Patient Safety Agency (2007) Recognising and responding appropriately to early signs of deterioration in hospitalised patients, London: National Patient Safety Agency.
Royal College of Physicians (2017) National early warning score (NEWS) 2: standardising the assessment of acute‐illness severity in the NHS, London: Royal College of Physicians.
Conclusion
SBAR and RSVP are tools that can be used to communicate or escalate concerns about a patient’s health. Continuity of patient care is achieved by the clear and concise transfer of patient clinical information from one healthcare provider to another during handover.
Effective communication is key in providing safe patient care. Communication failure in a healthcare setting has the potential to lead to serious medical errors.
Sharing patient‐specific healthcare information during handover requires situational awareness. In the hospital setting, most of the communication related to patient care occurs between nurses and physicians.
References
1 Featherstone, P., Chalmers, T. and Smith, G. (2008) RSVP: a system for communication of deterioration in hospital patients, British Journal of Nursing, 17(8): 860–864.
2 Ford, S. (2015) Communication errors behind third of hospital complaints. [online] Available: https://www.nursingtimes.net/roles/nurse‐managers/communication‐errors‐behind‐third‐of‐hospital‐complaints‐22‐09‐2015/. Accessed 2 October 2019.
3 Hill, W. and Nyce, J. (2010) Human factors in clinical shift handover communication, Canadian Journal of Respiratory Therapy, 46(1): 44–51.
4 Institute for Innovation and Improvement. (2010) Safer care SBAR implementation and training guide, Coventry: Institute for Innovation and Improvement.
5 Müller,