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4
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[1
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S
.
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e
Ba
se
d
M
e
d
icin
e
In
it
iativ
e
In
De
v
e
lo
p
in
g
Co
u
n
tri
e
s
f
o
r
S
e
rio
u
s
A
d
v
e
rse
Ev
e
n
ts,
”
In
ter
n
a
ti
o
n
a
l
J
o
u
rn
a
l
Crit
ica
l
Ill
n
e
s
s
In
ju
ry
S
c
ien
c
e
,
v
o
l.
4
,
n
o
.
1
,
p
p
.
3
-
9
,
2
0
1
4
.
[5
]
D.
Jo
n
e
s,
e
t
a
l.
,
“
T
h
e
Ra
p
id
Re
sp
o
n
se
S
y
ste
m
a
n
d
En
d
-
of
-
L
i
f
e
Ca
r
e
,
”
Cu
rr
e
n
t
Op
in
io
n
Crit
ica
l
Ca
r
e
,
v
o
l.
1
9
,
n
o
.
6
,
p
p
.
6
1
6
-
6
2
3
,
2
0
1
3
.
[6
]
S
.
M
o
n
a
n
g
i,
e
t
a
l.
,
“
A
n
a
l
y
sis
of
F
u
n
c
ti
o
n
i
n
g
a
n
d
Ef
f
i
c
ien
c
y
of
A
Co
d
e
Blu
e
S
y
ste
m
In
A
Tertiar
y
Ca
re
Ho
sp
it
a
l,
”
S
a
u
d
i
J
o
u
rn
a
l
A
n
e
sth
e
sia
,
v
o
l.
1
2
,
n
o
.
2
,
p
p
.
2
4
5
-
2
4
9
,
2
0
1
8
.
[7
]
P
.
J.
S
h
a
re
k
,
e
t
a
l.
,
“
Ef
f
e
c
t
of
A
Ra
p
id
Re
sp
o
n
se
T
e
a
m
on
Ho
sp
it
a
l
-
W
id
e
M
o
rtalit
y
a
n
d
Co
d
e
Ra
tes
Ou
tsid
e
T
h
e
ICU In
A
Ch
il
d
re
n
’
s
Ho
sp
it
a
l
,
”
J
a
ma
,
v
o
l
.
2
9
8
,
n
o
.
1
9
,
p
p
.
2
2
6
7
-
2
2
7
4
,
2
0
0
7
.
[8
]
M
.
S
a
b
a
h
i,
e
t
a
l.
,
“
Ef
f
ica
c
y
of
A
Ra
p
id
Re
sp
o
n
se
T
e
a
m
on
Re
d
u
c
in
g
T
h
e
In
c
id
e
n
c
e
a
n
d
M
o
rtalit
y
of
Un
e
x
p
e
c
ted
Ca
rd
iac
A
rre
sts,”
T
ra
u
ma
M
o
n
th
l
y
,
v
o
l.
1
7
,
n
o
.
2
,
p
p
.
2
7
0
-
2
7
4
,
2
0
1
2
.
[9
]
S
.
D.
M
a
rsh
a
ll
e
t
a
l.
,
“
W
h
y
Do
n
’
t
Ho
sp
it
a
l
S
taf
f
Ac
ti
v
a
te
T
h
e
R
a
p
id
Re
sp
o
n
se
S
y
ste
m
(RRS
)?
Ho
w
F
re
q
u
e
n
tl
y
I
s
It
Ne
e
d
e
d
a
n
d
Ca
n
T
h
e
P
ro
c
e
ss
B
e
Im
p
ro
v
e
d
?
,
”
Imp
lem
e
n
t
a
ti
o
n
S
c
i
e
n
c
e
,
v
o
l.
6
,
n
o
.
1
,
p
.
3
9
,
2
0
1
1
.
[1
0
]
H.
Ho
g
a
n
,
e
t
a
l
.
,
“
E
ff
e
c
ti
v
e
n
e
ss
o
f
wa
y
s
to
i
m
p
ro
v
e
d
e
tec
ti
o
n
a
n
d
re
sc
u
e
o
f
d
e
terio
ra
ti
n
g
p
a
ti
e
n
ts,
”
Br
it
ish
J
o
u
rn
a
l
Ho
sp
it
a
l
M
e
d
icin
e
(
L
o
n
d
).
,
v
o
l.
7
8
,
n
o
.
3
,
p
p
.
1
5
0
-
1
5
9
,
2
0
1
7
.
[1
1
]
S
.
K
i
t
t
o
e
t
a
l
.
,
“
R
a
p
i
d
R
e
s
p
o
n
s
e
S
y
s
t
e
m
s
a
n
d
C
o
l
l
e
c
t
i
v
e
(
I
n
)
C
o
m
p
e
t
e
n
c
e
:
A
n
E
x
p
l
o
r
a
t
o
r
y
A
n
a
l
y
s
i
s
of
I
n
t
r
a
p
r
o
f
e
s
s
i
o
n
a
l
a
n
d
I
n
t
e
r
p
r
o
f
e
s
s
i
o
n
a
l
A
c
t
i
v
a
t
i
o
n
F
a
c
t
o
r
s
,
”
J
o
u
r
n
a
l
I
n
t
e
r
p
r
o
f
es
s
i
o
n
a
l
C
a
r
e
,
v
o
l
.
2
9
,
n
o
.
4
,
p
p
.
3
4
0
-
3
4
6
,
2
0
1
5
.
[1
2
]
K.
S
.
A
stro
th
,
e
t
a
l.
,
"
A
M
e
a
su
re
of
F
a
c
il
it
a
to
rs
a
n
d
Ba
rriers
T
o
Ra
p
id
Re
sp
o
n
se
T
e
a
m
Ac
ti
v
a
ti
o
n
,
”
Ap
p
li
e
d
Nu
rs
in
g
Res
e
a
rc
h
,
v
o
l.
3
3
,
p
p
.
1
7
5
-
17
9
,
2
0
1
7
.
[1
3
]
W
.
L
.
Ch
u
a
,
M
.,
e
t
a
l.
,
“
F
a
c
to
rs
In
f
lu
e
n
c
in
g
T
h
e
A
c
ti
v
a
ti
o
n
of
T
h
e
Ra
p
id
Re
sp
o
n
se
S
y
ste
m
f
o
r
Cli
n
ica
ll
y
De
terio
ra
ti
n
g
P
a
ti
e
n
ts
By
F
ro
n
tl
i
n
e
W
a
rd
Cli
n
icia
n
s:
A
S
y
ste
m
a
ti
c
Re
v
ie
w
,
”
J
o
u
rn
a
l
In
ter
n
a
ti
o
n
a
l
Qu
a
l
ity
He
a
l
th
Ca
re
:
v
o
l.
2
9
,
n
o
.
8
,
p
p
.
9
8
1
-
9
9
8
,
2
0
1
7
.
[1
4
]
S
.
H
.
J
e
n
k
i
n
s
,
K
.
S
.
A
s
t
r
o
t
h
,
a
n
d
W
.
M
.
W
i
t
h
,
"
N
o
n
-
C
r
i
t
ic
a
l
-
Ca
r
e
N
u
r
s
e
s
’
P
e
r
c
e
p
t
i
o
n
s
of
F
a
c
i
l
i
t
a
t
o
r
s
a
n
d
B
a
r
r
i
e
r
s
T
o
R
a
p
i
d
R
e
s
p
o
n
s
e
T
e
a
m
A
c
t
i
v
a
t
i
o
n
.
,
”
J
o
u
r
n
a
l
N
u
r
s
e
s
P
r
o
f
e
s
s
i
o
n
a
l
D
e
v
o
l
e
p
m
e
n
t
,
v
o
l
.
3
1
,
n
o
.
5
,
p
p
.
2
6
4
-
2
7
0
,
2
0
1
5
.
[1
5
]
S.
Ro
b
b
i
n
s,
T
.
Ju
d
g
e
,
"
Or
g
a
n
iza
ti
o
n
a
l
b
e
h
a
v
io
r
,
"
1
2
e
d
.
,
Ja
k
a
rta:
S
a
lem
b
a
Emp
a
t
,
2
0
0
8
.
[1
6
]
S
.
L
a
u
ri,
S
.
S
a
lan
terä
,
“
De
v
e
lo
p
i
n
g
A
n
In
stru
m
e
n
t
to
M
e
a
su
re
a
n
d
De
sc
rib
e
Cli
n
ica
l
De
c
isio
n
M
a
k
in
g
i
n
Dif
f
e
re
n
t
Nu
rsin
g
F
ield
s,”
J
o
u
rn
a
l
Pr
o
f
e
ss
io
n
a
l
Nu
rs
i
n
g
,
v
o
l.
1
8
,
n
o
.
2
,
p
p
.
9
3
-
1
0
0
,
2
0
0
2
.
[1
7
]
W
.
J.
M
u
n
tea
n
,
“
Nu
rsin
g
c
li
n
ica
l
d
e
c
isio
n
-
m
a
k
in
g
:
A
li
tera
tu
re
re
v
iew
,
”
NCS
BN
Exe
c
.
S
u
mm
.
,
p
p
.
1
-
2
4
,
2
0
1
2
.
[1
8
]
S
.
No
t
o
a
tm
o
d
jo
,
"
He
a
lt
h
P
r
o
m
o
ti
o
n
,
T
h
e
o
ry
a
n
d
A
p
p
li
c
a
ti
o
n
s
,"
Ja
k
a
rta:
Ri
e
n
k
a
Cip
t
a
,
2
0
1
2
.
[1
9
]
N.
Ba
k
a
li
s,
G
.
S
.
Bo
w
m
a
n
,
a
n
d
D.
P
o
r
o
c
k
,
“
De
c
isio
n
M
a
k
in
g
i
n
G
re
e
k
a
n
d
En
g
li
sh
Re
g
istere
d
Nu
rse
s
i
n
Co
r
o
n
a
ry
Ca
re
Un
it
s,”
In
ter
n
a
ti
o
n
a
l
J
o
u
r
n
a
l
Nu
rs
in
g
S
tu
d
ies
,
v
o
l.
4
0
,
n
o
.
7
,
p
p
.
7
4
9
-
7
6
0
,
2
0
1
3
.
[2
0
]
L
.
S
tu
b
b
in
g
s,
W
.
Ch
a
b
o
y
e
r,
a
n
d
A
.
M
c
M
u
rra
y
,
“
Nu
rse
s
’
U
se
of
S
it
u
a
ti
o
n
Aw
a
re
n
e
ss
In
De
c
isio
n
‐M
a
k
in
g
:
A
n
In
teg
ra
ti
v
e
Re
v
i
e
w
,
”
J
o
u
rn
a
l
Ad
v
a
n
c
e
d
N
u
rs
in
g
,
v
o
l.
6
8
,
n
o
.
7
,
p
p
.
1
4
4
3
-
1
4
5
3
,
2
0
1
2
.
[2
1
]
Y.
P
u
rw
a
n
to
,
“
T
h
e
De
c
isio
n
-
M
a
k
in
g
Be
h
a
v
io
r
of
Nu
rse
s
a
n
d
P
a
ra
m
e
d
ics
In
Eme
rg
e
n
c
y
S
it
u
a
ti
o
n
,
”
J
u
rn
a
l
Pen
e
li
t
i
Hu
m.
,
v
o
l.
6
,
n
o
.
1
,
p
p
.
4
0
-
5
8
,
2
0
0
5
.
[2
2
]
J.
E.
P
re
tz
a
n
d
V
.
N.
F
o
lse
,
“
Nu
rsin
g
Ex
p
e
rien
c
e
a
n
d
P
re
f
e
re
n
c
e
f
o
r
In
tu
it
io
n
In
De
c
isio
n
M
a
k
in
g
.
,
”
J
o
u
rn
a
l
Cli
n
ica
l
Nu
rs
in
g
,
v
o
l
.
2
0
,
n
o
.
1
9
-
2
0
,
p
p
.
2
8
7
8
-
2
8
8
9
,
2
0
1
1
.
[2
3
]
H.
M
.
Ho
d
g
e
tt
s,
e
t
a
l.
,
“
S
e
e
No
Ev
il
:
Co
g
n
it
iv
e
Ch
a
ll
e
n
g
e
s
of
S
e
c
u
ri
ty
S
u
rv
e
il
lan
c
e
a
n
d
M
o
n
it
o
ri
n
g
,
”
J
o
u
rn
a
l
o
f
Ap
p
li
e
d
Res
e
a
rc
h
i
n
M
e
mo
ry
a
n
d
Co
g
n
it
i
o
n
,
v
o
l.
6
,
n
o
.
3
,
p
p
.
2
3
0
-
2
4
3
,
2
0
1
7
.
[2
4
]
A
.
M
o
h
a
m
m
e
d
,
e
t
a
l.
,
“
Kn
o
w
led
g
e
M
a
n
a
g
e
m
e
n
t,
De
c
isio
n
-
M
a
k
in
g
S
ty
l
e
a
n
d
Org
a
n
iza
ti
o
n
a
l
P
e
rf
o
rm
a
n
c
e
,
”
J
o
u
rn
a
l
In
n
o
v
a
ti
o
n
K
n
o
wl
e
d
g
e
,
v
o
l.
4
,
n
o
.
2
,
p
p
.
1
0
4
-
1
1
4
,
2
0
1
7
.
[2
5
]
Ra
m
e
z
a
n
i
-
Ba
d
r,
Na
sra
b
a
d
i,
Y.
Z.
T
a
le
g
h
a
n
i,
“
S
trate
g
ies
a
n
d
Crit
e
ria
f
o
r
Cli
n
ica
l
De
c
isio
n
M
a
k
in
g
I
n
Crit
ica
l
Ca
re
Nu
rse
s: A
Qu
a
li
tativ
e
S
tu
d
y
,
”
J
o
u
rn
a
l
Nu
rs
in
g
S
c
h
o
la
rs
h
ip
,
v
o
l
.
4
1
,
n
o
.
4
,
p
p
.
3
5
1
-
3
5
8
,
2
0
1
0
.
[2
6
]
P
.
Ha
ss
a
n
i,
e
t
a
l.
,
“
Us
e
of
In
tu
it
io
n
By
Crit
ica
l
Ca
re
Nu
rse
s:
A
P
h
e
n
o
m
e
n
o
lo
g
ica
l
S
t
u
d
y
,
”
Ad
v
a
n
c
e
s
M
e
d
ica
l
Ed
u
c
a
ti
o
n
Pra
c
t
ice
,
v
o
l.
7
,
p
p
.
6
5
-
7
1
,
F
e
b
.
2
0
1
6
.
[2
7
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