Marjon Borgert

53 Emergency care for false arrests Although, the majority of the patients with FAs seem to have non-urgent symptoms, it is noteworthy to mention that these symptoms often exist prior to cardiac arrests. 20-22 Therefore, even these less urgent calls must be taken seriously. 11 This indicates the importance of following the complete RRS protocol. It starts by measuring the vital signs and MEWS frequently to detect patients who are at risk for clinical deterioration. When reaching a prede ned threshold nurses should act on this by either calling the primary physician or RRT. By measuring the MEWS nurses will have a clear guideline on how to act when patients clinically deteriorate and who to call. The remaining FAs were classi ed as ‘urgent calls’, because at least one serious clinical symptom was observed. 8,19,20 Despite the urgency of these calls, these are still de ned as FAs according to the Utstein guidelines. Nevertheless, given the severity of the symptoms, immediate response of an emergency team is required. Since the CAT attends to patients within 2 minutes, the CAT is the most suitable team to activate for urgent FAs. Opportunities for enhancement Although this study was not designed to consider e ciency or potential improvements, the results could still be used to enhance emergency care. Previous studies have shown that cardiac arrests are not unpredictable events. More than 80% of the patients have identi able signs of physical deterioration in the hours prior to cardiac arrests. 20,21,23 However, incomplete vital sign or MEWS measurements often exists. 24-26 It is known that the respiratory rate, in particular, is often not recorded. 24,27 This is in spite of the fact that there is evidence that an abnormal respiratory rate is an important predictor of serious AEs. 27,28 Nurses do not always recognise symptoms of physical deterioration and this can lead to delayed care. 29,30 This is also associated with decreased survival from in- hospital cardiac arrests 29 and lower survival rates. 30 Protocols are available for activating emergency teams. However, protocols are often not followed completely. 25,26,31 Education could help with implementation. 25,32 Measuring the MEWS more often could also help. Standardized measurements of the MEWS 3 times daily signi cantly improves the correct measurement of the MEWS, i.e. recording of all 8 MEWS parameters. 24 The Utstein guideline was developed in order to monitor CAT performances and the e ects on patient outcomes. 10 By collecting and reviewing performance data the quality of emergency care can be improved and risks can be reduced. A guideline in the Utstein format for standardising RRT calls, performances and calling criteria is available 33 , although not widely used in the literature. Another point emerging from this discussion is the possibility of making one of the teams redundant by either merging the teams or rearranging the team compositions. Originally, the RRT superseded the traditional CAT 34 and responded to all types of in-hospital emergency care including cardiac arrests. The