Korean J Crit Care Med.  2017 May;32(2):133-141. 10.4266/kjccm.2016.01011.

A Pilot Study of the Effectiveness of Medical Emergency System Implementation at a Single Center in Korea

• Lee SH
• Leem AY
• Nho Y
• Kim YA
• Kim KD
• Kim YS
• Kim SK
• Chung KS

• KMID: 2384038
• DOI: http://doi.org/10.4266/kjccm.2016.01011

Abstract

BACKGROUND
An automatic alarm system was developed was developed for unexpected vital sign instability in admitted patients to reduce staffing needs and costs related to rapid response teams. This was a pilot study of the automatic alarm system, the medical emergency system (MES), and the aim of this study was to determine the effectiveness of the MES before expanding this system to all departments.
METHODS
This retrospective, observational study compared the performance of patients admitted to the pulmonary department at a single center using patient data from three 3-month periods (before implementation of the MES, December 2013-February 2014; after implementation of the MES, December 2014-February 2015 and December 2015-February 2016).
RESULTS
A total of 571 patients were admitted to the pulmonary department during the three observation periods. During this pilot study, the MES automatically issued 568 alarms for 415 admitted patients. There was no significant difference in the rate of cardiopulmonary resuscitation (CPR) before and after application of the MES. The mortality rate also did not change. However, it appeared that CPR was prevented in four patients admitted from the general ward to the intensive care unit (ICU) during MES implementation. The median length of hospital stay and median length of ICU stay were not significantly different before and after MES implementation.
CONCLUSIONS
Although we did not find a significant improvement in outcomes upon MES implementation, the CPR rate and mortality rate did not increase despite increased comorbidities. This was a small pilot study and, based on these results, we believe that the MES may have significant effects in longer-term and larger-scale studies.

Keyword

clinical alarms; critical care; intensive care units; internal medicine; monitoring, physiologic

MeSH Terms

Cardiopulmonary Resuscitation
Clinical Alarms
Comorbidity
Critical Care
Emergencies*
Humans
Intensive Care Units
Internal Medicine
Korea*
Length of Stay
Monitoring, Physiologic
Mortality
Observational Study
Patients' Rooms
Pilot Projects*
Retrospective Studies
Vital Signs

Figure

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  Figure 1. Design of the medical emergency system (MES). When a nurse enters vital sign data into the electronic medical record system, the computer automatically analyzes this information. If vital signs meet the MES criteria, a message is automatically sent to the primary doctor, resident, and on-call doctor. A doctor who receives the message must treat the patient and chart the treatment to deactivate the MES. If the MES is not deactivated, the system will continue to send the message to the doctors. EMR: electronic medical record; SMS: short message service.

• 

  Figure 2. Protocol for the medical emergency system. Management flow for (A) shock, (B) hypoxemia and tachypnea, (C) tachycardia. SBP: systolic blood pressure; SpO2: oxygen saturation; RR: respiratory rate; HR: heart rate; EMR; electronic medical record; GCS: glasgow coma scale; MES: medical emergency system; qSOFA: quick sepsis related organ failure assessment; CBC: complete blood count; diff: differential count; T.bil: total bilirubin; Cr: creatinine; ABGA: arterial blood gas analysis; EKG: electrocardiogram; CXR: chest X-ray; MAP: mean arterial pressure; ICU: intensive care unit; Tx: treatment; HAT; hypotension, altered mental status, tachypnea; BP: blood pressure; Resp: respiration; COPD: chronic obstructive pulmonary disease; PTE: pulmonary thromboembolism; CT: computed tomography; TTE: transthoracic echocardiogram; AVNRT: atrioventricular nodal reentrant tachycardia; AVRT: atrioventricular reentrant tachycardia; VT: ventricular tachycardia; VF: ventricular fibrillation; DDx: differential diagnosis; A-fib: atrial fibrillation; PSVT: paroxysmal supraventricular tachycardia. aEye response, 1–4; verbal response,1–5; motor response, 1–6.

• 

  Figure 3. Number of medical emergency system (MES) to turn on and time of MES calls.

Reference

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