Rapid Response System Improves Sepsis Bundle Compliances and Survival in Hospital Wards for 10 Years

Background: Hospitalized patients can develop septic shock at any time. Therefore, it is important to identify septic patients in hospital wards and rapidly perform the optimal treatment. Although the sepsis bundle has already been reported to improve survival rates, the controversy over evidence of the effect of in-hospital sepsis continues to exist. We aimed to estimate the outcomes and bundle compliance of patients with septic shock in hospital wards managed through the rapid response system (RRS). Methods: A retrospective cohort study of 976 patients with septic shock managed through the RRS at an academic, tertiary care hospital in Korea from 2008 to 2017. Results: Of the 976 enrolled patients, the compliance of each sepsis bundle was high (80.8–100.0%), but the overall success rate of the bundle was low (58.3%). The compliance rate for achieving the overall sepsis bundle increased from 26.5% to 70.0%, and the 28-day mortality continuously decreased from 50% to 32.1% over 10 years. We analyzed the two groups according to whether they completed the overall sepsis bundle or not. Of the 976 enrolled patients, 569 (58.3%) sepsis bundles were completed, whereas 407 (41.7%) were incomplete. The complete bundle group showed lower 28-day mortality than the incomplete bundle group (37.1% vs. 53.6%, p < 0.001). In the multivariate multiple logistic regression model, the 28-day mortality was significantly associated with the complete bundle (adjusted odds ratio (OR), 0.61; 95% confidence intervals (CI), 0.40–0.91; p = 0.017). The obtaining of blood cultures (adjusted OR, 0.45; 95% CI, 0.33–0.63; p < 0.001) and lactate re-measurement (adjusted OR, 0.69; 95% CI, 0.50–0.95; p = 0.024) in each component of the sepsis bundle were associated with the 28-day mortality. Conclusions: The rapid response system provides improving sepsis bundle compliances and survival in patients with septic shock in hospital wards.

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Rapid Response System Improves Sepsis Bundle Compliances & Survival in Hospital Wards for 10 Years

10.21203/rs.3.rs-773981/v1 ◽

2021 ◽

Author(s):

Sunhui Choi ◽

Jeongsuk Son ◽

Jin Won Huh ◽

Chae-Man Lim ◽

Dong Kyu Oh ◽

...

Keyword(s):

Septic Shock ◽

Compliance Rate ◽

Tertiary Care ◽

Rapid Response ◽

Care Hospital ◽

Rapid Response System ◽

Sepsis Bundles ◽

Response System ◽

Sepsis Bundle ◽

Hospital Wards

Abstract Background Hospitalized patients can develop septic shock at any time. Therefore, it is important to identify septic patients in hospital wards and rapidly perform the optimal treatment. Although the sepsis bundle has already been reported to improve survival rates, the controversy over evidence of the effect of in-hospital sepsis continues to exist. We aimed to estimate the outcomes and bundle compliance of patients with septic shock in hospital wards managed through the rapid response system (RRS). Methods Retrospective cohort study of 976 patients with septic shock managed through the RRS at an academic, tertiary care hospital in South Korea from 2008 to 2017. Results Of the 976 enrolled patients, the compliance of each sepsis bundle was high (80.8–100.0%), but the overall success rate of the bundle was low (58.3%). The compliance rate for achieving the overall sepsis bundle increased from 26.5–70.0%, and the 28-day mortality continuously decreased from 50–32.1% over 10 years. We analyzed the two groups according to whether they completed the overall sepsis bundle or not. Of the 976 enrolled patients, 569 (58.3%) sepsis bundles were completed, whereas 407 (41.7%) were incomplete. The complete bundle group showed lower 28-day mortality than the incomplete bundle group (37.1% vs. 53.6%, p < 0.001). In the multivariate multiple logistic regression model, the 28-day mortality was significantly associated with the complete bundle (adjusted odds ratio (OR), 0.58; 95% confidence intervals (CI), 0.39–0.87; p = 0.008). Obtention of blood cultures (adjusted OR, 0.45; 95% CI, 0.33–0.63; p < 0.001) and lactate remeasurement (adjusted OR, 0.69; 95% CI, 0.50–0.95; p = 0.024) in each component of the sepsis bundle were associated with the 28-day mortality. Conclusions The rapid response system provides improving sepsis bundle compliances and survival in patients with septic shock in hospital wards.

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Evaluating the Long-Term Trends and Impact of a Rapid Response System in a Single-Center, Tertiary-Care Hospital

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a2456 ◽

2019 ◽

Author(s):

T. Lee ◽

G. Lighthall

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Rapid Response ◽

Care Hospital ◽

Single Center ◽

Rapid Response System ◽

Response System ◽

Long Term Trends

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Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: Quality in practice

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa114 ◽

2020 ◽

Author(s):

Hermano Alexandre Lima Rocha ◽

Antonia Célia de Castro Alcântara ◽

Fernanda Colares de Borba Netto ◽

Flavio Lucio Pontes Ibiapina ◽

Livia Amaral Lopes ◽

...

Keyword(s):

Tertiary Care ◽

Rapid Response Team ◽

Lessons Learned ◽

Rapid Response ◽

Initial Assessment ◽

Care Hospital ◽

Large Tertiary Care ◽

Response Team ◽

Hospital Wards ◽

The Impact

Abstract Quality problem or issue Up to 13 July 2020, >12 million laboratory-confirmed cases of coronavirus disease of 2019 (COVID-19) infection have been reported worldwide, 1 864 681 in Brazil. We aimed to assess an intervention to deal with the impact of the COVID-19 pandemic on the operations of a rapid response team (RRT). Initial assessment An observational study with medical record review was carried out at a large tertiary care hospital in Fortaleza, a 400-bed quaternary hospital, 96 of which are intensive care unit beds. All adult patients admitted to hospital wards, treated by the RRTs during the study period, were included, and a total of 15 461 RRT calls were analyzed. Choice of solution Adequacy of workforce sizing. Implementation The hospital adjusted the size of its RRTs during the period, going from two to four simultaneous on-duty medical professionals. Evaluation After the beginning of the pandemic, the number of treated cases in general went from an average of 30.6 daily calls to 79.2, whereas the extremely critical cases went from 3.5 to 22 on average. In percentages, the extremely critical care cases went from 10.47 to 20%, with P < 0.001. Patient mortality remained unchanged. The number of critically ill cases and the number of treated patients increased 2-fold in relation to the prepandemic period, but the effectiveness of the RRT in relation to mortality was not affected. Lessons learned The observation of these data is important for hospital managers to adjust the size of their RRTs according to the new scenario, aiming to maintain the intervention effectiveness.

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