Marjon Borgert

47 Emergency care for false arrests INTRODUCTION Increasing economic restraints and awareness about patient safety mean hospitals are encouraged to evaluate their care processes. 1 This should lead to a more e cient healthcare delivery and an improvement of the quality of care. The process of activating teams that are 24/7 on standby in case of medical emergencies, i.e. the traditional Cardiac Arrest Teams (CATs) and the more recently introduced Rapid Response Teams (RRTs), could potentially managed more e ciently. Approximately 80% of patients have vital signs abnormalities in the 24 hours prior to Adverse Events (AEs), i.e. cardiac arrests, unplanned intensive care unit admissions and unexpected death. 2,3 These abnormalities could be detected in an early stage, by measuring the vital signs frequently. To aid in this detection process the Modi ed Early Warning Score (MEWS) has been developed. This is a tool whereby nurses allocate points to the measurement of vital signs resulting in a summary score. 4,5 When reaching a prede ned threshold nurses should act by either calling the doctor on duty or emergency teams. In the Netherlands there are di erences in organisation between the emergency teams. The CAT, with an average of four members, is responsible for immediate response for patients su ering from cardiac arrests. 3 The RRT, with generally two members responds within 10 minutes for evaluation, triage and treatment of patients who clinically deteriorate to prevent them from su ering an AE. 2,3,6,7 CATs are focussed on cardiopulmonary resuscitation or unexpected life-threatening medical emergencies. They intervene according to strict advanced resuscitation protocols 8 , while RRTs have speci c expertise in care for clinically deteriorating patients before the occurrence of cardiac arrests. 3 The most common reasons for calling RRTs are hypoxia, hypotension, altered conscious state, tachycardia or oliguria. 9 To monitor CAT performances and outcomes, hospitals are registering CAT activations according to the international Utstein guideline. 10 In a substantial number, CATs are activated while patients do not su er from cardiac arrests. These activations are called ‘false arrests’ (FAs). 11-14 For these calls basic or advanced life-support is not needed 10 and immediate response of the larger CAT may not be necessary. More importantly, previous studies have shown that most patients with FAs have signs of clinical deterioration that are commonly seen prior to cardiac arrests. 13 CATs are frequently activated for FAs, proportions ranging from 8% to 30%. 11-13 Nevertheless, the characteristics of these calls are hardly ever reported in detail and little information is available about their medical urgencies. It is suggested that the RRT would be an appropriate and more e cient team