scholarly journals Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259577
Author(s):  
Lorena Micheline Alves Silva ◽  
Diego Marques Moroço ◽  
José Paulo Pintya ◽  
Carlos Henrique Miranda
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Early Warning ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Before And After ◽  
Response Team

Background Emergency department (ED) crowding is a frequent situation. To decrease this overload, patients without a life-threating condition are transferred to wards that offer ED support. This study aimed to evaluate if implementing a rapid response team (RRT) triggered by the modified early warning score (MEWS) in high-risk wards offering ED support is associated with decreased in-hospital mortality rate. Methods A before-and-after cross-sectional study compared in-hospital mortality rates before and after implementation of an RRT triggered by the MEWS ≥4 in two wards of a tertiary hospital that offer ED support. Results We included 6863 patients hospitalized in these wards before RRT implementation from July 2015 through June 2017 and 6944 patients hospitalized in these same wards after RRT implementation from July 2018 through June 2020. We observed a statistically significant decrease in the in-hospital mortality rate after intervention, 449 deaths/6944 hospitalizations [6.47% (95% confidence interval (CI) 5.91%– 7.07%)] compared to 534 deaths/6863 hospitalizations [7.78% (95% CI 7.17–8.44)] before intervention; with an absolute risk reduction of -1.31% (95% CI -2.20 –-0.50). Conclusion RRT trigged by the MEWS≥4 in high-risk wards that offer ED support was found to be associated with a decreased in-hospital mortality rate. A further cluster-randomized trial should evaluate the impact of this intervention in this setting.

Abstract 288: Rapid Response Team Implementation Associated with Reductions in In-hospital Mortality Rate and Hospitalization Costs: A Retrospective Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jacob Sessim Filho ◽  
Renato P Azevedo ◽  
Antonildes N Assuncao ◽  
Marcia M Sa ◽  
Felipe D Silva ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Statistical Power ◽  
Early Recognition ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Clinical Deterioration ◽  
Medical Database ◽  
Hospitalization Costs ◽  
Response Team

Introduction: Early recognition of clinical deterioration in inpatient subjects seems to be one of the main factors associated with prevention of in-hospital severe adverse events occurrence. Previous studies failed to demonstrate that the implementation of a rapid response team (RRT) could reduce in-hospital mortality rate. Hypothesis: Could a RRT implementation reduces in-hospital mortality and/or hospitalizations costs in a private general hospital in Brazil? Methods: This is a retrospective cohort built from data of electronic medical database of consecutive adult inpatients admitted to general wards who had to be transferred to an ICU after an acute clinical deterioration between May 1st, 2012 and June 30th, 2016. Subjects were divided into two groups as follows: group 1 (G1) with those admitted to ICU before RRT implementation on June 1st, 2014 and group 2 (G2) with the ones admitted to ICU after the implementation. All patients in G2 received care by the RRT before ICU admittance. In cases in which a patient had more than one hospital admission, only the first admittance was used for analyses. Results: Patients data are shown in table 1.Outcome data are shown in table 2. Conclusions: From these data, it is possible to infer that this RRT implementation at this hospital was associated with improvement in clinical outcomes of inpatients who needed an ICU admittance after an acute clinical deterioration, as well as a significant reduction of their hospitalization costs. These data reinforce the hypotheses that MERIT study was underpowered. Further multicenter randomized trials, with appropriate statistical power, shall be proposed to address these questions.

scholarly journals Reduced frequency of cardiopulmonary arrests by rapid response teams

2012 ◽  
Vol 10 (4) ◽  
pp. 442-448 ◽  
Author(s):  
Paulo David Scatena Gonçales ◽  
Joyce Assis Polessi ◽  
Lital Moro Bass ◽  
Gisele de Paula Dias Santos ◽  
Paula Kiyomi Onaga Yokota ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Rapid Response Team ◽  
Rapid Response ◽  
High Complexity ◽  
Rapid Response Teams ◽  
Cardiorespiratory Arrest ◽  
Reduced Frequency ◽  
Before And After ◽  
Response Team ◽  
The Impact

OBJECTIVE: To evaluate the impact of the implementation of a rapid response team on the rate of cardiorespiratory arrests in mortality associated with cardiorespiratory arrests and on in-hospital mortality in a high complexity general hospital. METHODS: A retrospective analysis of cardiorespiratory arrests and in-hospital mortality events before and after implementation of a rapid response team. The period analyzed covered 19 months before intervention by the team (August 2005 to February 2007) and 19 months after the intervention (March 2007 to September 2008). RESULTS: During the pre-intervention period, 3.54 events of cardiorespiratory arrest/1,000 discharges and 16.27 deaths/1,000 discharges were noted. After the intervention, there was a reduction in the number of cardiorespiratory arrests and in the rate of in-hospital mortality; respectively, 1.69 events of cardiorespiratory arrest/1,000 discharges (p<0.001) and 14.34 deaths/1,000 discharges (p=0.029). CONCLUSION: The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.

Early Warning Score Communication Bundle: A Pilot Study

2018 ◽  
Vol 27 (3) ◽  
pp. 238-242
Author(s):  
Cheryl Gagne ◽  
Susan Fetzer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Warning ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Early Warning Scores ◽  
Response Team ◽  
Intensive Care Unit Nurses ◽  
The Impact

Background Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. Objective To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer. Methods After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation. Results Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002). Conclusion Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.

scholarly journals National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Joonas Tirkkonen ◽  
Sari Karlsson ◽  
Markus B. Skrifvars
Keyword(s):  
Observational Study ◽  
Early Warning ◽  
Prospective Observational Study ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Hospital Death ◽  
Hospital Patient ◽  
Response Team ◽  
National Early Warning Score

Abstract Background The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. Methods We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. Results The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively. Conclusions We found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

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.

Can Early Warning Systems Enhance Detection of High Risk Patients by Rapid Response Teams?

2021 ◽  
pp. 088506662097814
Author(s):  
Peter M. Reardon ◽  
Andrew J. E. Seely ◽  
Shannon M. Fernando ◽  
Simon Didcote ◽  
Iain Strachan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Early Warning ◽  
Tertiary Care ◽  
Warning System ◽  
Rapid Response Team ◽  
Early Warning Systems ◽  
Rapid Response ◽  
Warning Systems ◽  
Prognostic Accuracy ◽  
Response Team

Purpose: We sought to evaluate if incorporating an early warning system (EWS), the Visensia Safety Index (VSI) and the National Early Warning Systems 2 (NEWS2), may lead to earlier identification of rapid response team (RRT) patients. Methods: This was a retrospective study (2015-2018) of patients experiencing RRT activation within a tertiary care network. We evaluated the proportion of patients with an EWS alert prior to RRT activation and their associated outcomes (primary: hospital mortality). Results: There were 6,346 RRT activations over the study period. Of these, 2042 (50.8%) patients would have had a VSI alert prior to RRT activation, with a median advanced time of 3.6 (IQR 0.5-12.8) hours, compared to 2351 (58.4%) patients and 9.8 (IQR 2.0-18.7) hours for NEWS2. Patients with a potential alert prior to RRT activation had an increased odds of mortality for both VSI (OR 1.2, 95%CI 1.1-1.3) and NEWS2 (OR 2.7, 95% CI 2.4-3.1). Prognostic accuracy for hospital mortality was similar between groups. Conclusion: Utilization of an EWS by an RRT has potential to provide earlier recognition of deterioration and mortality risk among hospitalized inpatients.

National Early Warning Score vs Rapid Response Team criteria-Prevalence, misclassification, and outcome

2018 ◽  
Vol 63 (2) ◽  
pp. 215-221 ◽  
Author(s):  
Ola Friman ◽  
Max Bell ◽  
Therese Djärv ◽  
Andreas Hvarfner ◽  
Gabriella Jäderling
Keyword(s):  
Early Warning ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Response Team ◽  
National Early Warning Score

scholarly journals Characteristics and Outcomes of Patients Activated by Rapid Response Team Who Transferred to the Intensive Care Unit

2021 ◽  
Author(s):  
Song-I Lee ◽  
Jeong suk Koh ◽  
Yoon-joo Kim ◽  
Da Hyun Kang ◽  
Jeong Eun Lee
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Medical Center ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
High Heart Rate ◽  
Factors Affecting ◽  
Response Team

Abstract Background:The utilization of a Rapid response team (RRT) has influenced patient’s clinical outcomes in the general ward. However, characteristics of RRT-screened patients admitted in the ward or transferred to the intensive care unit (ICU) is unknown. Therefore, this study aimed to evaluate these factors.Methods:We conducted a retrospective study using patient’s data in a tertiary medical center in Korea between January 2016 and December 2017. Results: Total 1,096 patients were included; 389 patients were transferred to the ICU, and 707 patients stayed in the ward. The ICU group was more likely to be admitted for medical reasons, hepatobiliary disease, and high heart rate. More interventions were performed, hospital stays were longer, and 28-day and in-hospital mortality were higher in the ICU group. Multivariate logistic regression analyses showed that the risk factors affecting ICU admission were Sequential Organ Failure Assessment (SOFA) score, and National Early Warning Score (NEWS), platelet and lactate level. Transfer to the ICU was not associated with in-hospital mortality.Conclusions: Among RRT-activated patients, those with higher SOFA, NEWS scores, and lactate levels were more likely to transfer to the ICU. Therefore, these patients should be closely monitored and considered for ICU transfer.

Sign in / Sign up

Export Citation Format

Share Document