Critical Appraisal: Effectiveness of Rapid Response System

Critical Appraisal
Name
Institute of Affiliation
Date
Critical Appraisal
Introduction
In critical appraisal process, the evidence based practice is presented about a given issue. Its principal aim is to identify methodological flaws in the literature and provide consumers of research data the opportunity to make informed decisions about the quality of research evidence. The process ensures that carefulness and a systematic examination of the research to judge its trustworthiness, its value, and appropriateness in a particular situation. Critical appraisal is regarded to be an essential element of evidence based in the field of medicine. For example, in this case, the principal evaluation of the rapid response systems was discussed and also the challenges faced by the deaf when the loved ones die. When the process is conducted using a fundamental criteria, for instance, the methodology of acquiring data and analysis is considered to be the key in leading to get an amicable solution to the issue. Other aspects considered are the relevance of the research question, does it add anything new and also whether the study addressed the key potential sources of bias (Stewart &Parmar, 1996).
In this paper, two articles have been considered for critical appraisal. The first article is about the effectiveness of rapid response system. It focuses on what will happen to the patients when the system works efficiently or entirely fail to work. For example, in this case, it was found that if the system is not monitored well, then the health of those in ICU keeps on deteriorating. The article was written by three scholars, Ritesh Maharaj, Ivan Raffaele and Julia Wendon. The aim of the article was to establish the effectiveness of the rapid response system, and whether they are associated with a reduction in hospital mortality and cardiopulmonary arrest. Also, it focused on whether the presence of a physician in the rapid response system is significantly associated with a mortality reduction (Maharaj, Raffaele, & Wendon, 2015). The second article is about the challenges the deaf face in the case they have lost the loved ones who are mainly the member of the family. It was written by Karen A. Kehl, Ph.D., RN, ACHPN and Constance M. Gartner to identify critical challenges the deaf people have encountered when loved ones die at the University of Wisconsin in Madison. The research was based on the experience of the deaf person who lost a loved one. In this case, Robert was found to be a victim and therefore was interviewed. Robert was regarded since he was the only college educated older deaf male who could use the American Sign Language well hence communication process was not a barrier to the process. He was interviewed about the challenges he faced interacting with the health care system as three of his loved ones were dying. Approval for the study was received from the Social Sciences institutional review board at the University of Wisconsin-Madison. The methods considered in the first article apprised was majorly looking at the statistics particularly the effect the system had caused when it came to using. The second section approach involved the use of a victim person who may give the accurate reflection of the challenges encountered (Dacey, ER, Wilcox, Doherty M, &Boyer., 2007).
Article One: RSS
In the first case rapid response system teams were set to ensure the effectiveness of the scheme, whether effective or ineffective. According to the research conducted by various scholars, the health status of many patients may deteriorate to an unexpected extent of ICU admission if the RRS systems cannot be monitored well (Liberati, et al., 2009).The study aimed at establishing the effectiveness of the use of the scheme. It was also to check whether the closer presence of a specialist in the system significantly was related to the decrease in the number of deaths. Furthermore, its aim was to assess the effects of the RRS on hospital mortality and cardiopulmonary arrest outside the ICU. It was also to evaluate the potential relationship between the numbers of RRS team activations per every a thousand admissions (Maharaj, Raffaele, &Wendon, 2015).
The methodology used was a systematic review of studies published data retrieved from various databases such as PubMed among many others. Therefore, critical data analysis was employed in getting the information needed. The researchers also included studies that reported data on the primary outcomes of ICU and in-hospital mortality or cardiopulmonary arrests. The nine eligible groups were identified and used to carry out the process. The comparisons were made to come up with a meaningful conclusion that was based on the data collected. Additionally, a hand search of bibliographies of the leading publications was performed. The method selected is regarded to be appropriate for determining the effectiveness of the system as it required real practical work based on the actual situation and not working on the assumptions. Many sources which were primary were employed contributing to the effectiveness of the process. The statistics were taken when the system was used and when its use was limited which to a profound extent provided reliable outcomes; hence, the method used was appropriate (Liberati, et al., 2009).
The analysis of the data was performed in small groups of adults and pediatrics with further subgroups by study design (cluster randomized control trial (CRCT), interrupted time series and controlled before–after versus before–after studies with no contemporaneous controls and observational studies). Quantitative analysis was performed using an intention to treat analysis, and the RR and 95 % confidence intervals (CIs) were calculated. Researchers used the method proposed by Higgins to measure inconsistency between study results, reported as the I2 statistic as well as the 95 % CI. Publication bias was evaluated using the contour funnel plot asymmetry and the Harbord modification of the Egger test.The analysis method used was the best of other methods, for instance, the graphical evaluation could be subjective hence was not used.
The findings were that the implementation of RRS in the adult population was associated with an overall reduction in hospital mortality (RR 0.87, 95 % CI 0.81–0.95, p <0.001) as figure two showed. There was evidence of considerable heterogeneity (I2 = 86 %, p <0.001). The treatment effect in the cluster randomized trials, controlled before–after and interrupted time series studies was RR 0.91 (95 % CI 0.85–0.97) with less heterogeneity (I2 = 3 %). In the pediatric population, RRS also showed a reduction in mortality (RR 0.82, 95 % CI 0.76–0.89) with significant heterogeneity (I2 = 78 %). The implementation of RRS in the adult population was associated with an overall reduction in cardiopulmonary arrests (RR 0.65, 95 % CI 0.61–0.70, p <0.001) with substantial heterogeneity (I2 = 70 %, p <0.001). The treatment effect in the cluster randomized trials, controlled before–after and interrupted time series studies subgroup was RR 0.74 (95 % CI 0.56–0.98) with less heterogeneity (I2 = 0 %). In the pediatric population, RRS also showed a reduction in cardiopulmonary arrests (RR = 0.64, 95 % CI 0.55– 0.74) with minimal heterogeneity (I2 = 7 %). The implementation of RRS in the adult population has not been associated with a significant effect on the number of ICU admissions (RR 0.90, 95 % CI 0.70–1.16, p = 0.43). None of the pediatric studies reported the effect of RRS teams on the number of ICU admissions. Only 10 of the adult research gave the impacts of RRS teams on the number ICU admissions and therefore it was not well covered.
Firstly, the study answered the research questions and the research aims were successfully achieved. Secondly, the study was of significance in many ways since the researchers were able to know that RRS teams are effective in reducing hospital mortality in both adult and pediatric inpatients. It also helped to know that RRS teams also reduce hospital cardiac arrest. Through conducted the research, it was established that the vast majority of rapid response interventions do not require a physician and the presence of a physician was not associated with improved outcomes. The research will help the doctors to use the system freely knowing its positive significance. Hence, it has added much value to service provision. The study concludes that RRS teams associate with a reduction in hospital mortality and cardiac arrest. These findings did not show any significant publication bias. A sensitivity analysis revealed that the study results were robust to the addition of a new study. We were unable to demonstrate any benefit from the presence of a physician on the RRS team, the duration of implementation or the number of activations. While RRS teams are very much part of the landscape in man...