J Korean Med Sci.  2021 Jan;36(2):e7. 10.3346/jkms.2021.36.e7.

Rapid Response System Should Be Enhanced at Non-general Ward Locations: a Retrospective Multicenter Cohort Study in Korea

• Kang BJ
• Hong SB
• Jeon K
• Lee SM
• Lee DH
• Moon JY
• Lee YJ
• Kim JS
• Park J
• Ahn JJ

• KMID: 2510594
• DOI: http://doi.org/10.3346/jkms.2021.36.e7

Abstract

Background
A rapid response system (RRS) contributes to the safety of hospitalized patients. Clinical deterioration may occur in the general ward (GW) or in non-GW locations such as radiology or dialysis units. However, there are few studies regarding RRS activation in non-GW locations. This study aimed to compare the clinical characteristics and outcomes of patients with RRS activation in non-GW locations and in the GW.
Methods
From January 2016 to December 2017, all patients requiring RRS activation in nine South Korean hospitals were retrospectively enrolled and classified according to RRS activation location: GW vs non-GW RRS activations.
Results
In total, 12,793 patients were enrolled; 222 (1.7%) were non-GW RRS activations. There were more instances of shock (11.6% vs. 18.5%) and cardiac arrest (2.7% vs. 22.5%) in non-GW RRS activation patients. These patients also had a lower oxygen saturation (92.6% ± 8.6% vs. 88.7% ± 14.3%, P < 0.001) and a higher National Early Warning Score 2 (7.5 ± 3.4 vs. 8.9 ± 3.8,P < 0.001) than GW RRS activation patients. Although non-GW RRS activation patients received more intubation (odds ratio [OR], 3.135; P < 0.001), advanced cardiovascular life support (OR, 3.912; P < 0.001), and intensive care unit transfer (OR, 2.502;P < 0.001), their hospital mortality (hazard ratio, 0.630; P = 0.013) was lower than GW RRS activation patients upon multivariate analysis.
Conclusion
Considering that there were more critically ill but recoverable cases in non-GW locations, active RRS involvement should be required in such locations.

Keyword

Heart Arrest; Hospital Rapid Response Team; Intensive Care Units; Patients' Rooms; Shock

Figure

• 

  Fig. 1 Causes of rapid response system activation for general ward and non-general ward rapid response system activation.GW = general ward, RRS = rapid response system.aShock includes that because of septic, cardiac, anaphylactic, hypovolemic, obstructive, and other causes; bOthers include causes such as arrhythmia, metabolic acidosis, hypertension, education of medical staff, procedure call, and transportation.

• 

  Fig. 2 Forest plot analysis of rapid response system interventions and hospital mortality in patients with general ward and non-general rapid response system activations.Statistical comparisons of the data performed using univariate and multivariate logistic regression analyses related with intubation, ACLS, and ICU transfer, and using univariate and multivariate Cox regression analyses related with hospital death.ACLS = advanced cardiovascular life support, CI = confidence interval, GW = general ward, HFNC = high flow nasal cannula, ICU = intensive care unit, OR = odds ratio, RRS = rapid response system.aHazard ratio analyzed by Cox regression analysis.

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