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.

scholarly journals In-hospital emergency: how to identify the patient in crisis

2015 ◽  
Vol 9 (3) ◽  
pp. 69-78
Author(s):  
Marcello Difonzo ◽  
Antonio Bisceglie
Keyword(s):  
Intensive Care ◽  
Rapid Response System ◽  
Ward Staff ◽  
Hospital Emergency ◽  
Serious Adverse Events ◽  
Afferent Limb ◽  
Response System ◽  
Adequate Response ◽  
Medical Emergencies ◽  
General Wards

In-hospital emergency is a system designed to ensure an adequate response, in rapidity and appropriateness, to cardiac arrests and other medical emergencies, in general wards and in not-medical areas of the hospital. Early treatment of unstable patients, hospitalized in non-intensive care unit, reduces the incidence of serious adverse events such as unexpected cardiac arrest, unplanned intensive care admissions, and unexpected death.The Rapid Response System (RRS) describes the entire process of in-hospital emergency planning. The afferent limb of the RRS is the way, managed by the ward staff, doctors and nurses, to identify the patient in crisis, at risk of physiological deterioration, and enable an appropriate response. The afferent limb includes the monitoring, the recognition of patient’s deterioration and the activation of the emergency team.The aim of this study is to describe the dynamics of the afferent limb, focusing on the evidence about early detection of the clinical deterioration in a general ward.

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 Improving rapid response system performance in a Chinese Joint Commission International Hospital

2019 ◽  
Vol 47 (7) ◽  
pp. 2961-2969
Author(s):  
Minfei Yang ◽  
Lanlan Zhang ◽  
Yuwei Wang ◽  
Yue Zhan ◽  
Xiaofei Zhang ◽  
...  
Keyword(s):  
Medical Emergency Team ◽  
Joint Commission ◽  
Rapid Response ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Serious Adverse Events ◽  
Emergency Team ◽  
Response System ◽  
Joint Commission International ◽  
The Impact

Objective To assess the impact of a regional rapid response system (RRS) implemented in a Chinese Joint Commission International Hospital on the timely treatment of patients with serious adverse events (SAEs). Methods Clinical SAEs, activation periods, reasons for RSS activation, and patient outcomes were assessed using SAE response sheets at admission to the hospital and over 31 months of follow-up. Results We found that 192 events were called by medical staff and 6 were called by auxiliary staff. Reasons for the 385 RRS activations included: unconsciousness (133; 34.5%), and airway obstruction and absent carotid pulse (49 each; 12.7%). The average arrival time of the medical emergency team was 2.4 ± 0.1 minutes. There were 123 (62.1%) RRS activations during daytime working hours (8:00–17:00); CPR was performed in 86 (43.4%) cases. Outcomes of RRS were: vital signs stabilized in 82 (41.4%) patients and 61 (30.8%) patients were transferred to ICU. Conclusion Our experience showed that the regional RRS has led to better integrated multidisciplinary cooperation and reduced time for treating patients with SAEs, resulting in success of the RRS.

276: THE EFFECT OF A RAPID RESPONSE SYSTEM ON POSTOPERATIVE PATIENTS: A NATIONWIDE DATABASE ANALYSIS

2016 ◽  
Vol 44 (12) ◽  
pp. 146-146
Author(s):  
Yoshiki Sento ◽  
Takaki Naito ◽  
Kazuaki Atagi ◽  
Shigeki Fujitani ◽  
Satoshi Osaga ◽  
...  
Keyword(s):  
Rapid Response ◽  
Rapid Response System ◽  
Database Analysis ◽  
Nationwide Database ◽  
Response System

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.

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.

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