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 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 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.

scholarly journals Evaluation of the SpO2/FiO2 ratio as a predictor of intensive care unit transfers in respiratory ward patients for whom the rapid response system has been activated

PLoS ONE ◽  
2018 ◽  
Vol 13 (7) ◽  
pp. e0201632 ◽  
Author(s):  
Won Gun Kwack ◽  
Dong Seon Lee ◽  
Hyunju Min ◽  
Yun Young Choi ◽  
Miae Yun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Rapid Response ◽  
Rapid Response System ◽  
Response System

Rapid response teams for the critically ill

2016 ◽  
Author(s):  
Ken Hillman ◽  
Jack Chen
Keyword(s):  
Intensive Care ◽  
Early Stage ◽  
Vital Signs ◽  
Rapid Response ◽  
Serious Adverse Events ◽  
Rapid Response Systems ◽  
Acute Hospitals ◽  
Response Systems ◽  
General Wards ◽  
Seriously Ill

There is a high incidence of potentially preventable deaths and serious adverse events in acute hospitals. Most of these events occur on the general wards of the hospital. The concept of rapid response systems was developed as a way of identifying seriously-ill and at-risk patients in acute hospitals at an early stage in order to improve outcomes. The system has two major components—criteria to define the deteriorating patient linked to a rapid response. The criteria are based on a combination of abnormal vital signs and observations, and the response is based on matching the patient with staff with the appropriate skills. Implementing and evaluating hospital-wide systems present new challenges that are different to our approach to a new drug or procedure. As well as agreeing to the appropriate criteria and response, the system needs leadership and support across the whole hospital, including education programmes and, monitoring with appropriate quality assurance activities. Increasingly, the specialty of intensive care is designed around the needs of the seriously ill, rather than being geographically confined within the four walls of an intensive care unit. The concept of rapid response systems is part of that process.

scholarly journals Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography

2020 ◽  
Vol 76 (12) ◽  
pp. 3548-3562 ◽  
Author(s):  
Duncan Smith ◽  
Martin Cartwright ◽  
Judith Dyson ◽  
Jillian Hartin ◽  
Leanne M. Aitken
Keyword(s):  
Nursing Staff ◽  
Rapid Response ◽  
Rapid Response System ◽  
Focused Ethnography ◽  
Afferent Limb ◽  
Response System
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