To investigate how the mechanisms of implementation and the characteristics of context combine to enable or constrain the implementation of Rapid Response Systems and the achievement of desired outcomes.
There is limited evidence to explain why Rapid Response Systems work or do not work as research to date has primarily focused on measuring patient outcomes without considering the complex nature of the intervention.
We searched DARE, CENTRAL, NHSEED, MEDLINE, Medline In Process, Embase, CINAHL, PubMed, Scopus, The Web of Science and PychInfo databases from 1997-2017 in addition to purposively searching the grey literature, citation and snowball searching and contacting professional groups looking for articles supporting, refuting or explaining Rapid Response System programme theories.
Included studies were critically appraised and graded using the Critical Appraisal Skills Programme tool. Data extraction and synthesis investigated the Rapid Response System theoretical propositions against the empirical evidence in order to refine programme theories.
The review found that the Rapid Response System programme theory achieved desired outcomes when there were sufficient skills mix of experienced staff, EWS protocols were used flexibly alongside clinical judgement and staff had access to ongoing, multiprofessional, competency based education. However, ward cultures, hierarchical referral systems, workload and staffing resources impacted negatively on the implementation of the Rapid Response System.
To improve the recognition and management of patient deterioration policymakers need to address those cultural, educational and organisational factors that impact on the successful implementation of Rapid Response Systems in practice.
- EWS protocols; Realist review; nursing; patient deterioration
- Rapid Response Systems