scholarly journals Trends of in-hospital cardiac arrests in a single tertiary hospital with a mature rapid response system

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262541
Author(s):  
Hohyung Jung ◽  
Ryoung-Eun Ko ◽  
Myeong Gyun Ko ◽  
Kyeongman Jeon
Keyword(s):  
Hospital Mortality ◽  
Poisson Regression ◽  
Regression Models ◽  
Tertiary Hospital ◽  
Rapid Response ◽  
Rapid Response System ◽  
Quality Metric ◽  
Response System ◽  
Annual Changes ◽  
General Wards

Background Most studies on rapid response system (RRS) have simply focused on its role and effectiveness in reducing in-hospital cardiac arrests (IHCAs) or hospital mortality, regardless of the predictability of IHCA. This study aimed to identify the characteristics of IHCAs including predictability of the IHCAs as our RRS matures for 10 years, to determine the best measure for RRS evaluation. Methods Data on all consecutive adult patients who experienced IHCA and received cardiopulmonary resuscitation in general wards between January 2010 and December 2019 were reviewed. IHCAs were classified into three groups: preventable IHCA (P-IHCA), non-preventable IHCA (NP-IHCA), and inevitable IHCA (I-IHCA). The annual changes of three groups of IHCAs were analyzed with Poisson regression models. Results Of a total of 800 IHCA patients, 149 (18.6%) had P-IHCA, 465 (58.1%) had NP-IHCA, and 186 (23.2%) had I-IHCA. The number of the RRS activations increased significantly from 1,164 in 2010 to 1,560 in 2019 (P = 0.009), and in-hospital mortality rate was significantly decreased from 9.20/1,000 patients in 2010 to 7.23/1000 patients in 2019 (P = 0.009). The trend for the overall IHCA rate was stable, from 0.77/1,000 patients in 2010 to 1.06/1,000 patients in 2019 (P = 0.929). However, while the incidence of NP-IHCA (P = 0.927) and I-IHCA (P = 0.421) was relatively unchanged over time, the incidence of P-IHCA decreased from 0.19/1,000 patients in 2010 to 0.12/1,000 patients in 2019 (P = 0.025). Conclusions The incidence of P-IHCA could be a quality metric to measure the clinical outcomes of RRS implementation and maturation than overall IHCAs.

scholarly journals Predictors of in-hospital Mortality After Rapid Response System Activation in a Newly Established Tertiary Hospital

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Büşra Tezcan ◽  
Müçteba Can ◽  
Çilem Bayındır Dicle ◽  
İbrahim Mungan ◽  
Derya Ademoğlu
Keyword(s):  
Hospital Mortality ◽  
Tertiary Hospital ◽  
Rapid Response ◽  
Rapid Response System ◽  
Response System ◽  
System Activation

scholarly journals Clinical Observation Research on the Application of Rapid Response System in General Wards

2021 ◽  
Author(s):  
Yan Wang ◽  
Haiyan Wu ◽  
Chang Liu ◽  
Suping Ran ◽  
Baoyu Wang
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Observation ◽  
Blood Purification ◽  
Rapid Response ◽  
Call Rate ◽  
Vasoactive Drugs ◽  
Rapid Response System ◽  
Organ Function ◽  
Response System ◽  
General Wards

Abstract Objective Observe and analyze the effect of the criticall rapid response system in general wards.Methods Analyze the data of CROT cases initiated in 2016-2019, and statistically analyze the reasons for the initiation, on-site treatment, the outcomes of patients, and the number of organ function support of patients transferred to ICU. Results A total of 312 cases were initiated in 43 months. The top three reasons for initiation were: unconsciousness (29.79%), respiratory distress (19.17%), and hypotension (18.60%). The effective call rate was 91.99%, and only 68.27% were transferred to ICU. Mechanical ventilation (89.67%), blood purification (85.92%), and vasoactive drugs (82.16%) were applied in ICU. Conclusions The critical rapid response system can guarantee the safety of inpatients in general wards, but the activatiaon characteristics are worthy of further discussion.

scholarly journals Effect of a rapid response system on code rates and in-hospital mortality in medical wards

2019 ◽  
Vol 34 (4) ◽  
pp. 246-254 ◽  
Author(s):  
Hong Yeul Lee ◽  
Jinwoo Lee ◽  
Sang-Min Lee ◽  
Sulhee Kim ◽  
Eunjin Yang ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Rapid Response ◽  
Rapid Response System ◽  
Response System ◽  
Medical Wards

Post‐operative alarm signs in the rapid response system and hospital mortality after non‐cardiac surgery

2020 ◽  
Vol 64 (10) ◽  
pp. 1431-1437
Author(s):  
In‐Ae Song ◽  
Jun Kwon Cha ◽  
Tak Kyu Oh ◽  
Yeon Joo Lee ◽  
You Hwan Jo ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Rapid Response ◽  
Rapid Response System ◽  
Response System

scholarly journals The characteristics, types of intervention, and outcomes of postoperative patients who required rapid response system intervention: a nationwide database analysis

2021 ◽  
Author(s):  
Yoshiki Sento ◽  
◽  
Masayasu Arai ◽  
Yuji Yamamori ◽  
Shinsuke Fujiwara ◽  
...  
Keyword(s):  
Postoperative Management ◽  
Rapid Response ◽  
Rapid Response System ◽  
Low Oxygen ◽  
Hospital Emergency ◽  
Database Analysis ◽  
Fluid Bolus ◽  
Serious Adverse Events ◽  
Response System ◽  
General Wards

Abstract Purpose Improving the safety of general wards is a key to reducing serious adverse events in the postoperative period. We investigated the characteristics, treatment, and outcomes of postoperative patients managed by a rapid response system (RRS) in Japan to improve postoperative management. Methods This retrospective study analyzed cases requiring RRS intervention that were included in the In-Hospital Emergency Registry in Japan. We analyzed data reported by 34 Japanese hospitals between January 2014 and March 2018, mainly focusing on postoperative patients for whom the RRS was activated within 7 days of surgery. Non-postoperative patients, for whom the RRS was activated in all other settings, were used for comparison as necessary. Results There were 609 (12.7%) postoperative patients among the total patients in the registry. The major criteria were staff concerns (30.2%) and low oxygen saturation (29.7%). Hypotension, tachycardia, and inability to contact physicians were observed as triggers significantly more frequently in postoperative patients when compared with non-postoperative patients. Among RRS activations within 7 days of surgery, 68.9% of activations occurred within postoperative day 3. The ordering of tests (46.8%) and fluid bolus (34.6%) were major interventions that were performed significantly more frequently in postoperative patients when compared with non-postoperative patients. The rate of RRS activations resulting in ICU care was 32.8%. The mortality rate at 1 month was 16.2%. Conclusion Approximately, 70% of the RRS activations occurred within postoperative day 3. Circulatory problems were a more frequent cause of RRS activation in the postoperative group than in the non-postoperative group.

Outcomes following changing from a two-tiered to a three-tiered hospital rapid response system

2019 ◽  
Vol 43 (2) ◽  
pp. 178
Author(s):  
The Concord Medical Emergency Team Study Investigators
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Structured Interviews ◽  
Emergency Team ◽  
Response System

Objectives The aim of the present study was to determine whether changing a hospital rapid response system (RRS) from a two-tiered to a three-tiered model can reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. Methods Staff at an Australian teaching hospital attending medical emergency team and cardiac arrest (MET/CA) calls were interviewed after the RRS was changed from a two-tiered to three-tiered model, and the results were compared with a study using the same methods conducted before the change. The main outcome measures were changes in: (1) the incident rate resulting from staff leaving normal duties to attend MET/CA calls; (2) the cardiac arrest rate, (3) unplanned intensive care unit (ICU) admission rates; and (4) hospital mortality. Results We completed 1337 structured interviews (overall response rate 65.2%). The rate of incidents occurring as a result of staff leaving normal duties to attend MET/CA calls fell from 213.7 to 161.3 incidents per 1000 MET/CA call participant attendances (P<0.001), but the rate of cardiac arrest and unplanned ICU admissions did not change significantly. Hospital mortality was confounded by the opening of a new palliative care ward. Conclusion A three-tiered RRS may reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. What is known about the topic? RRS calls result in significant disruption to normal hospital routines because staff can be called away from normal duties to attend. The best staffing model for an RRS is currently unknown. What does this paper add? The present study demonstrates, for the first time, that changing a hospital RRS from a two-tiered to a three-tiered model can reduce the rate of incidents reported by staff caused by leaving normal duties to attend RRS calls while maintaining the same overall patient outcomes. What are the implications for practitioners? Hospitals could potentially reduce disruption to normal hospital routines, without compromising patient care, by changing to a three-tiered RRS.

scholarly journals Outcomes of rapid response team implementation in tertiary private hospitals: a prospective cohort study

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Awad Al-Omari ◽  
Abbas Al Mutair ◽  
Fadi Aljamaan
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Cardiopulmonary Arrest ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Dramatic Reduction ◽  
Rapid Response System ◽  
Private Hospitals ◽  
Response System ◽  
Response Team

Abstract Background Cardiopulmonary arrest may result in high mortality rate in hospitals where the rapid response team is not implemented. A rapid response system can recognize patients at high risk of cardiopulmonary arrest and provide the needed medical management to prevent further deterioration. The rapid response system has shown a dramatic reduction in mortality rate and cardiopulmonary arrest. Objective To evaluate the effectiveness of the rapid response team (RRT) implementation in reducing the mortality rate, number of cardiopulmonary arrests, and number of ICU admission. Design A pre- and post-rapid response team system implementation. Setting Four tertiary private hospitals in Saudi Arabia. Patients A total of 154,869 patients in the 3-year before rapid response system period (January 2010 to December 2012) and a total of 466,161 during the 2.5-year post-RRT implementation period (January 2014 to June 2016). Results Results indicated that ward nurses activated RRT more often than physicians (1104 activations [69%] vs. 499 activations [31%]), with cardiovascular and respiratory abnormalities being the most common triggers. Serious concern about the patient condition by the ward staff was the trigger for 181 (11.29%) activations. The RRT provided a variety of diagnostic and therapeutic interventions. Most patients cared for by RRT were admitted to ICU 1103 (68.81%), and the rest 500 (31.19%) were managed in the ward. After the implementation of the RRT project, the hospital mortality rate dropped from 7.8 to 2.8 per 1000 hospital admission. Hospital cardiopulmonary arrest rate has dropped from 10.53 per 1000 hospital admissions to 2.58. Rapid response team implementation also facilitated end-of-life care discussions. Conclusion Implementation of the RRT project has shown a dramatic reduction in the total ICU admissions, average ICU occupancy rate, total hospital mortality, and total ICU mortality. These findings reinforce the evidence that RRT implementation is effective in reducing hospital mortality and cardiopulmonary arrest rates in addition to other outcomes related to healthcare quality.

Abstract 153: Does the Revision of Resuscitation Guidelines Improve the Outcome of In-Hospital Cardiac Arrest?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Akihiro Miyake ◽  
Hiroshi Nonogi ◽  
Yoshihisa Fujimoto ◽  
Shinsuke Fujiwara ◽  
Takaki Naito ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Rapid Response ◽  
Rapid Response System ◽  
International Consensus ◽  
Response System ◽  
Shockable Rhythm ◽  
Resuscitation Guidelines ◽  
General Wards ◽  
Hospital Cardiac Arrest

Background: Resuscitation guidelines have been improved every five years using ILCOR international consensus and outcomes for out-of-hospital cardiac arrest improved. However, it remained unknown whether the outcome of in-hospital cardiac arrest has improved. The purpose of this research is to compare the outcomes of multicenter registrations in Japan and to consider the role of rapid response system (RRS). Methods: We compared the two multicenter prospective registrations for adult in-hospital cardiac arrest conducted in Japan. We compared the outcome of Japanese Registry of CPR (J-RCPR,12 hospitals) conducted in the "Guideline 2005" era and Japanese Registry for Survey Of in-hospital Resuscitation Trial (J-RESORT,8 hospitals) conducted in the "Guidelines 2010" era. We searched the number of hospitals participating in the rapid response system multicenter collaborative research (RRS) conducted in Japan. Results: J-RCPR had 491 cases, mean age 71 ± 15 years old, male 63%(311/491), J-RESORT 284 cases, mean age 72 ± 17 years old, male 68%(193/284). ROSC rate was 64.7% (318/491), 77.5% (220/284), respectively (p<0.05). The survival rate after 24 hours was 49.8% (245/491), 50.7% (144/284) (NS), the survival rate after 30 days was 27.8% (137/491), 33.1% (94/284) (NS), and the favorable neurological outcome rate (CPC 1 or CPC 2) was 21.4% (105/491), 22.9% (65/284) (NS), respectively. The proportion of witnessed cardiac arrest was 77.2% (379/491), 81.7% (232/284) (NS), the location of incidence in general wards was 54.0% (265/491), 46.1% (131/284) (NS), and the shockable rhythm was 28.1% (138/491), 22.5% (64/284) (NS), respectively. In both registries, the median interval from the occurrence of cardiac arrest to the initiation of resuscitation was 0 min. The proportion of participating hospitals to RRS was only 6 facilities in 2013 and increased to 41 facilities in 2016, but still less than 1% of the total number of hospitals in Japan. Conclusion: This study showed no improvement in the outcome of in-hospital cardiac arrest and very few hospitals using RRS during the past 10 years. To improve the outcome of the in-hospital cardiac arrest, it is necessary to investigate the nation-wide status of in-hospital cardiac arrest and the effectiveness of RRS.

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