Acute Crit Care.  2020 May;35(2):77-86. 10.4266/acc.2019.00661.

Effectiveness of a daytime rapid response system in hospitalized surgical ward patients

• Yang E
• Lee H
• Lee SM
• Kim S
• Ryu HG
• Lee HJ
• Lee J
• Oh SY

• KMID: 2502337
• DOI: http://doi.org/10.4266/acc.2019.00661

Abstract

Background
Clinical deteriorations during hospitalization are often preventable with a rapid response system (RRS). We aimed to investigate the effectiveness of a daytime RRS for surgical hospitalized patients.
Methods
A retrospective cohort study was conducted in 20 general surgical wards at a 1,779- bed University hospital from August 2013 to July 2017 (August 2013 to July 2015, pre-RRSperiod; August 2015 to July 2017, post-RRS-period). The primary outcome was incidence of cardiopulmonary arrest (CPA) when the RRS was operating. The secondary outcomes were the incidence of total and preventable cardiopulmonary arrest, in-hospital mortality, the percentage of “do not resuscitate” orders, and the survival of discharged CPA patients.
Results
The relative risk (RR) of CPA per 1,000 admissions during RRS operational hours (weekdays from 7 AM to 7 PM) in the post-RRS-period compared to the pre-RRS-period was 0.53 (95% confidence interval [CI], 0.25 to 1.13; P=0.099) and the RR of total CPA regardless of RRS operating hours was 0.76 (95% CI, 0.46 to 1.28; P=0.301). The preventable CPA after RRS implementation was significantly lower than that before RRS implementation (RR, 0.31; 95% CI, 0.11 to 0.88; P=0.028). There were no statistical differences in in-hospital mortality and the survival rate of patients with in-hospital cardiac arrest. Do-not-resuscitate decisions significantly increased during after RRS implementation periods compared to pre-RRS periods (RR, 1.91; 95% CI, 1.40 to 2.59; P<0.001).
Conclusions
The day-time implementation of the RRS did not significantly reduce the rate of CPA whereas the system effectively reduced the rate of preventable CPA during periods when the system was operating.

Keyword

cardiopulmonary resuscitation; heart arrest; hospital mortality; hospital rapid response team; patient safety

Figure

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  Figure 1. Monthly trends of rapid response system (RRS) activations per 1,000 admissions during the pre-RRS and RRS implementation periods. The blue bars represent the RRS call activation count per 1,000 admissions after RRS implementation (mean±standard deviation, 5.10±1.82). The orange bars represent the RRS proactive rounding (PR) activation count per month (15.90±9.99). The green circles and lines represent the total RRS activation counts per month (21.00±10.72). RRS activation cases included transferring a patient to the intensive care unit, RRS members delivering an advanced intervention, consultation, education, observation, or accompanying the transfer of ill patients to another location from the wards. EMR: electronic medical record.

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  Figure 2. Incidence of non-intensive care unit (ICU) cardiopulmonary arrests (CPAs) per 1,000 admissions. The blue squares and lines represent the total incidence of non-ICU CPAs per 1,000 admissions during the study periods regardless of rapid response system (RRS) operating hours (median, 0.41 vs. 0.31; P=0.301). The orange circles and dotted lines represent the incidence of non-ICU CPA per 1,000 admissions during RRS operating hours before and after implementation (median, 0.36 vs. 0.00; P=0.099). The green triangles and lines represent the incidence of non-ICU CPA per 1,000 admissions outside RRS operating hours before and after RRS implementation (median, 0.00 vs. 0.00; mean, 0.21 vs. 0.22; P=0.860).

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  Figure 3. Incidence of preventable non-intensive care unit (ICU) cardiopulmonary arrests (CPAs) per 1,000 admissions. The diamonds and lines represent the incidence of preventable non-ICU CPA per 1,000 admissions before and after rapid response system (RRS) implementation (median, 0.00 vs. 0.00; mean, 0.21 vs. 0.07; P=0.028).

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