Abstract:
INTRODUCTION:Rapid response systems (RRSs) have been introduced to facilitate effective 'rescue' of seriously ill patients on hospital wards. While research has demonstrated some benefit, uncertainty remains regarding impact on patient outcomes. Little is known about the relationship between social contexts and the application of the RRS. DESIGN:This comparative case study of the RRS within the medical services of two UK hospitals used ethnographic methods over a 12-month period in 2009, including observation (ward work and shadowing medical staff = 150 h), interviews with doctors, ward and critical care nurses, healthcare assistants, safety leads and managers (n=35), documentary review and analysis of routine data. Data were analysed using NVivo software. RESULTS:The RRS reduced variability in recording, recognition and response behaviour. The RRS formalised understandings of deterioration and provided a mandate for escalating care across professional and hierarchical boundaries. However, markers of deterioration not assimilated into risk scores were marginalised and it was harder for staff to escalate care without the 'objective evidence' provided by the score. Contextual features (eg, leadership, organisational culture and training) shaped implementation, utilisation and impact of the RRS. Reporting and feedback of audit data enabled learning about 'selected' escalation work on the wards. Difficulties with referral upwards and across medical boundaries were reported by junior medical staff. CONCLUSION:Locating a RRS within a pathway of care for the acutely ill patient illustrates the role of these safety strategies within the social organisation of clinical work. There is a need to broaden the focus of inquiry from detection and initiation of escalation (where the strategies are principally directed) towards team response behaviour and towards those medical response practices which to date have escaped scrutiny and monitoring.
journal_name
Postgrad Med Jjournal_title
Postgraduate medical journalauthors
Mackintosh N,Rainey H,Sandall Jdoi
10.1136/pgmj-2011-000147repsubject
Has Abstractpub_date
2012-05-01 00:00:00pages
261-70issue
1039eissn
0032-5473issn
1469-0756pii
pgmj-2011-000147repjournal_volume
88pub_type
杂志文章abstract::A 65 year old man was admitted with segmental consolidation of the left upper lobe after having stayed in a hotel for 2 days. He deteriorated rapidly on conventional antibiotic therapy and required ventilatory support. Acinetobacter calcoaceticus var. anitratus was grown from the sputum and blood cultures, which was t...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.69.818.934
更新日期:1993-12-01 00:00:00
abstract::In the changing National Health Service, there is an increasing awareness of stress related problems in the medical workforce. Mentorship has been shown to help with both stress reduction and adaptation to change. There are recognised difficulties with providing mentorship for doctors but there are ways in which these...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.2006.054155
更新日期:2007-05-01 00:00:00
abstract::Largyngotracheal and pharyngoesophageal tears following minor blunt trauma to the neck are uncommon. A child with such an injury is reported and the modes of diagnosis and management are discussed. Patients may initially present with minimal signs and symptoms, but their condition may deteriorate rapidly or insidiousl...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.75.887.548
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:Colonoscopy is the best way of imaging the colon with concurrent biopsy and treatment. However it is expensive, requires full bowel preparation, and carries a risk of complications. Flexible sigmoidoscopy is an alternative way to investigate symptoms that raise the suspicion of a lesion of the rectum or left...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pmj.2003.008540
更新日期:2004-02-01 00:00:00
abstract::Since January 1974, alternate cadaveric renal transplants were treated with antilymphocyte globulin (Behringwerke) om addotopm to prednisone and azathioprine. Thirty patients were treated in this way. 53% of patients receiving ALG had a functioning graft at six months as opposed to 40% in the control group. This diffe...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章
doi:
更新日期:1976-01-01 00:00:00
abstract::Tuberculous infection of the oesophagus is rare. This is confirmed by our present review of cases managed in our teaching hospitals over a period of 18 years which uncovered only 11 patients. The main presentation is that of dysphagia whose algorithm of investigation should seek to differentiate tuberculosis from carc...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.68.796.110
更新日期:1992-02-01 00:00:00
abstract:INTRODUCTION:Characteristics and outcomes of patients undergoing inferior vena cava (IVC) filter insertion are not well reported. Particularly, the role of long term anticoagulation in these patients is unclear. AIMS:(1) To describe in a cohort of patients undergoing IVC filter insertion, underlying diseases, indicati...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,多中心研究
doi:10.1136/pgmj.2005.037911
更新日期:2006-02-01 00:00:00
abstract::A previously undescribed type of congenital abdominal wall hernia is described. Presentation was with the symptoms and signs of subacute large bowel obstruction. The diagnosis was suggested by barium enema and confirmed at laparotomy. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.65.760.112
更新日期:1989-02-01 00:00:00
abstract::We report a case of persistent chorea as a manifestation of thyrotoxicosis. The chorea was severe and persisted after the patient was rendered euthyroid. Dopamine antagonists only partially suppressed the involuntary movements during the first few months. It was eventually controlled with haloperidol, but whenever she...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.64.756.789
更新日期:1988-10-01 00:00:00
abstract::Testis cancer is an increasing problem, especially in northern European male populations. However, survival has improved dramatically over one generation. Environmental factors may have a role in the aetiology with high oestrogen concentrations implicated. Testis cancer is subdivided between seminoma and non-seminoma....
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.2007.057992
更新日期:2007-10-01 00:00:00
abstract::The body composition of the 17 members of the BMRES was studied using body weight and fat fold calipers, with measurements of whole body potassium and nitrogen. The full assessment was made just before departure from Birmingham and immediately on return. Daily observations of body weight and fat folds were made during...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.55.645.475
更新日期:1979-07-01 00:00:00
abstract::" Blo -Bag", a new disposable spacer device, has been tested in conjunction with Duovent metered dose inhaler. Duovent produced a significant bronchodilatation for the duration of the study. When delivered by the " Blo -Bag" it produced a significantly greater increase in peak expiratory flow rate than when delivered ...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1984-01-01 00:00:00
abstract::This paper reviews the development of cerebral scintigraphy from its early days of planar imaging with simple technetium-99m labelled compounds to the recent revival of the technique in the form of positron-emission and single-photon emission tomography. A short explanation of instrumentation and radiopharmaceuticals ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.64.747.4
更新日期:1988-01-01 00:00:00
abstract::Four cases of severe osteolysis of bones subsequent to camel bite are described. The first had osteolysis of the ribs with traumatic diaphragmatic hernia. Two cases had similar appearances of gross osteolysis of the shafts of the radius and ulna, whilst one had osteolysis of the humeral shaft. The similarities in the ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.65.770.900
更新日期:1989-12-01 00:00:00
abstract:BACKGROUND:Epidemiological and family studies suggest that lung cancer results from the combined effects of age, smoking and genetic factors. Chronic obstructive pulmonary disease (COPD) is also an independent risk factor for lung cancer and coexists in 40-60% of lung cancer cases. METHODS:In a two-stage case-control ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,多中心研究
doi:10.1136/pgmj.2008.077107
更新日期:2009-10-01 00:00:00
abstract::Thirty-one patients with radiolucent common bile duct stones received medical treatment. Nineteen had Rowachol, a terpene preparation, eight (42%) achieving complete stone disappearance within 3 to 48 months. Fifteen (including 3 of the above) took Rowachol with bile acid (chenodeoxycholic in 11, ursodeoxycholic in 4)...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.61.714.313
更新日期:1985-04-01 00:00:00
abstract::A review of the role of presynaptic receptors in the modulation of neurotransmitter release indicates two types of presynaptic receptors. By means of presynaptic inhibitory autoreceptors a neurotransmitter can regulate its own release. In addition, presynaptic receptors are acted upon by other endogenous compounds, ei...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:
更新日期:1981-01-01 00:00:00
abstract::In 17 patients with essential hypertension administration of labetalol alone resulted in a significant reduction in supine systolic and diastolic blood pressure of 14% and 17%, respectively. Seven patients attained a diastolic pressure less than equal to 95 mmHg. A significant postural fall in systolic blood pressure ...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章
doi:
更新日期:1980-01-01 00:00:00
abstract::A multi-centre double-blind randomized study is reported in which the effect on mortality of oral disopyramide (300 mg loading dose, then 100 mg qds) was compared with placebo in 1985 patients entering hospital with suspected acute myocardial infarction. Treatment was commenced with 24 hr of onset of symptoms (mean ti...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/pgmj.60.700.98
更新日期:1984-02-01 00:00:00
abstract::Non-alcoholic fatty liver disease (NAFLD) is common and may progress to cirrhosis and its complications. The pathogenesis of steatosis and cellular injury is thought to be related mostly to insulin resistance and oxidative stress. Therefore, management entails identification and treatment of metabolic risk factors, im...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.2005.042200
更新日期:2006-05-01 00:00:00
abstract::The factors related to the occurrence of bacteraemia following urinary tract manipulation were studied in a large community hospital. During a 3-year period, forty-six of 326 episodes of hospital-acquired bacteraemia were associated with urinary tract manipulation. All thirty of forty-six cases felt to be definitely r...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.54.636.668
更新日期:1978-10-01 00:00:00
abstract:INTRODUCTION:Approximately 366 million people worldwide live with diabetes and this figure is expected to rise. Among the correct diagnosis, there will be errors in the diagnosis, classification and coding, resulting in adverse health and financial implications. AIM:To determine the prevalence and characteristics of d...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,多中心研究
doi:10.1136/postgradmedj-2013-132068
更新日期:2014-01-01 00:00:00
abstract:INTRODUCTION:Potentially inappropriate medication (PIM) prescribing is a global problem. Limited data are available on the prevalence of PIMs in elderly patients with chronic kidney disease (CKD). We examined the PIM prevalence in elderly patients with CKD, the most common drugs implicated and the levels of polypharmac...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2012-130889
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Benefits of exposure to global health training during medical education are well documented and residents' demand for this training is increasing. Despite this, it is offered by few US obstetrics and gynaecology (OBGYN) residency training programmes. OBJECTIVES:To evaluate interest, perceived importance, pr...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2014-133144
更新日期:2015-12-01 00:00:00
abstract::Paget's disease of bone is a relatively common condition in the UK affecting up to 5% of the population over the age of 55 years with particularly high prevalence in the North West of England. The majority of those affected are asymptomatic. Its precise cause remains unknown, and until recently, choice of treatment of...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.73.856.69
更新日期:1997-02-01 00:00:00
abstract:PURPOSE OF THE STUDY:The aim of this study was to investigate the association of fluid overload, measured by bioelectrical impedance vector analysis (BIVA) and also by accumulated fluid balance, with 30-day mortality rates in patients admitted to the emergency department (ED). DESIGN:We conducted a prospective observa...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2018-135695
更新日期:2018-07-01 00:00:00
abstract:PURPOSE:How medical students learn and develop the characteristics associated with good teaching in medicine is not well known. Information about this process can improve the academic preparation of medical students for teaching responsibilities. The purpose of this study was to determine how different experiences cont...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.2006.045393
更新日期:2006-09-01 00:00:00
abstract::A patient with systemic Castleman's disease (angiofollicular lymph node hyperplasia) including bone changes and peripheral neuropathy, is described. She also had pseudotumour cerebri, and, as this association has been reported previously, it is unlikely to be due to chance. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.64.749.217
更新日期:1988-03-01 00:00:00
abstract::We report what we believe is the first recorded case of Mondor's disease associated with metastatic lung cancer presenting in the breast. An association between Mondor's disease and primary breast cancer has been described previously. In patients with Mondor's disease and primary breast cancer has been described previ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.65.768.779
更新日期:1989-10-01 00:00:00
abstract::Ulcerative colitis is not commonly associated with recognizable pulmonary disease and only four sporadic cases of sarcoidosis in association with ulcerative colitis have been previously reported. However, in a series of 680 patients with ulcerative colitis, pulmonary or extra-pulmonary sarcoidosis has at some stage be...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.62.727.341
更新日期:1986-05-01 00:00:00