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Hosny R, Hussein RS, Hussein WM, Hakim SA, Habil IS. Effectiveness of Rapid Response Team implementation in a tertiary hospital in Egypt: an interventional study. BMJ Open Qual 2024; 13:e002540. [PMID: 39019587 PMCID: PMC11256054 DOI: 10.1136/bmjoq-2023-002540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 07/06/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Rapid response teams (RRTs) help in the early recognition of deteriorating patients in hospital wards and provide the needed management at the bedside by a qualified team. RRT implementation is still questionable because there is insufficient evidence regarding its effects. To date, according to our knowledge, no published studies have addressed the effectiveness of RRT implementation on inpatient care outcomes in Egypt. OBJECTIVE We aimed to assess the impact of an RRT on the rates of inpatient mortality, cardiopulmonary arrest calls and unplanned intensive care unit (ICU) admission in an Egyptian tertiary hospital. METHODS An interventional study was conducted at a university hospital. Data was evaluated for 24 months before the intervention (January 2018 till December 2019, which included 4242 admissions). The intervention was implemented for 12 months (January 2021 till December 2021), ending with postintervention evaluation of 2338 admissions. RESULTS RRT implementation was associated with a significant reduction in inpatient mortality rate from 88.93 to 46.44 deaths per 1000 discharges (relative risk reduction (RRR)=0.48; 95% CI, 0.36 to 0.58). Inpatient cardiopulmonary arrest rate decreased from 7.41 to 1.77 calls per 1000 discharges (RRR, 0.76; 95% CI, 0.32 to 0.92), while unplanned ICU admissions decreased from 5.98 to 4.87 per 1000 discharges (RRR, 0.19; 95% CI, -0.65 to 0.60). CONCLUSIONS RRT implementation was associated with a significantly reduced hospital inpatient mortality rate, cardiopulmonary arrest call rate as well as reduced unplanned ICU admission rate. Our results reveal that RRT can contribute to improving the quality of care in similar settings in developing countries.
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Affiliation(s)
- Rania Hosny
- Universal Health Insurance Authority, Cairo, Egypt
| | - Rasha Saad Hussein
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wafaa Mohamed Hussein
- Department of Healthcare Quality, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sally Adel Hakim
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ihab Shehad Habil
- Department of Healthcare Quality, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kim SH, Hong JY, Kim Y. Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study. J Korean Med Sci 2021; 36:e235. [PMID: 34402231 PMCID: PMC8369309 DOI: 10.3346/jkms.2021.36.e235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
We aimed to investigate the characteristics and prognosis of high risk hospitalized patients identified by the rapid response system (RRS). A multicentered retrospective cohort study was conducted from June 2019 to December 2020. The National Early Warning Score (NEWS) was used for RRS activation. The outcome was unexpected intensive care unit (ICU) admission within 24 hours after RRS activation. The 11,459 patients with RRS activations were included. We found distinct clinical characteristics in patients who underwent ICU admission. All NEWS parameters were associated with the risk of unexpected ICU admission except body temperature. Body mass index, pulmonary disease, and cancer are related to the decreased risk of unexpected ICU admission. In conclusion, there were differences in clinical characteristics among high risk patients, and those differences were associated with unexpected ICU admissions. Clinicians should consider factors relating to unexpected ICU admission in the management of high risk patients identified by RRS.
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Affiliation(s)
- Sang Hyuk Kim
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Young Hong
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Youlim Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
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Lee HY, Lee J, Lee SM, Kim S, Yang E, Lee HJ, Lee H, Ryu HG, Oh SY, Ha EJ, Ko SB, Cho J. Effect of a rapid response system on code rates and in-hospital mortality in medical wards. Acute Crit Care 2019; 34:246-254. [PMID: 31795622 PMCID: PMC6895472 DOI: 10.4266/acc.2019.00668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To determine the effects of implementing a rapid response system (RRS) on code rates and in-hospital mortality in medical wards. METHODS This retrospective study included adult patients admitted to medical wards at Seoul National University Hospital between July 12, 2016 and March 12, 2018; the sample comprised 4,224 patients admitted 10 months before RRS implementation and 4,168 patients admitted 10 months following RRS implementation. Our RRS only worked during the daytime (7 AM to 7 PM) on weekdays. We compared code rates and in-hospital mortality rates between the preintervention and postintervention groups. RESULTS There were 62.3 RRS activations per 1,000 admissions. The most common reasons for RRS activation were tachypnea or hypopnea (44%), hypoxia (31%), and tachycardia or bradycardia (21%). Code rates from medical wards during RRS operating times significantly decreased from 3.55 to 0.96 per 1,000 admissions (adjusted odds ratio [aOR], 0.29; 95% confidence interval [CI], 0.10 to 0.87; P=0.028) after RRS implementation. However, code rates from medical wards during RRS nonoperating times did not differ between the preintervention and postintervention groups (2.60 vs. 3.12 per 1,000 admissions; aOR, 1.23; 95% CI, 0.55 to 2.76; P=0.614). In-hospital mortality significantly decreased from 56.3 to 42.7 per 1,000 admissions after RRS implementation (aOR, 0.79; 95% CI, 0.64 to 0.97; P=0.024). CONCLUSIONS Implementation of an RRS was associated with significant reductions in code rates during RRS operating times and in-hospital mortality in medical wards.
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Affiliation(s)
- Hong Yeul Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sulhee Kim
- Rapid Response Team, Seoul National University Hospital, Seoul, Korea
| | - Eunjin Yang
- Rapid Response Team, Seoul National University Hospital, Seoul, Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Young Oh
- Department of General Surgery, Seoul National University Hospital, Seoul, Korea.,Critical Care Center, Seoul National University Hospital, Seoul, Korea
| | - Eun Jin Ha
- Critical Care Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Lee BY, Hong SB. Rapid response systems in Korea. Acute Crit Care 2019; 34:108-116. [PMID: 31723915 PMCID: PMC6786673 DOI: 10.4266/acc.2019.00535] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022] Open
Abstract
The inpatient treatment process is becoming more and more complicated with advanced treatments, aging of the patient population, and multiple comorbidities. During the process, patients often experience unexpected deterioration, about half of which might be preventable. Early identification of patient deterioration and the proper response are priorities in most healthcare facilities. A rapid response system (RRS) is a safety net to identify antecedents of these adverse events and to respond in a timely manner. The RRS has become an essential part of the medical system worldwide, supported by all major quality improvement organizations. An RRS consists of a trigger system and response team and needs constant assessment and process improvement. Although the effectiveness and cost-benefit of RRS remain controversial, according to previous studies, it may be beneficial by decreasing in-hospital cardiac arrest and mortality. Since the first implementation of RRS in Korea in 2008, it has been developed in over 15 medical centers and continues to expand. Recent accreditation standards and an RRS pilot program by the Korean government will promote the proliferation of RRSs in Korea.
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Affiliation(s)
- Bo Young Lee
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lee YJ, Lee DS, Min H, Choi YY, Lee EY, Song I, Yoon YE, Kim JW, Park JS, Cho YJ, Lee JH, Suh JW, Jo YH, Kim K, Park S. Differences in the Clinical Characteristics of Rapid Response System Activation in Patients Admitted to Medical or Surgical Services. J Korean Med Sci 2017; 32:688-694. [PMID: 28244298 PMCID: PMC5334170 DOI: 10.3346/jkms.2017.32.4.688] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/28/2016] [Indexed: 11/20/2022] Open
Abstract
Variability in rapid response system (RRS) characteristics based on the admitted wards is unknown. We aimed to compare differences in the clinical characteristics of RRS activation between patients admitted to medical versus surgical services. We reviewed patients admitted to the hospital who were detected by the RRS from October 2012 to February 2014 at a tertiary care academic hospital. We compared the triggers for RRS activation, interventions performed, and outcomes of the 2 patient groups. The RRS was activated for 460 patients, and the activation rate was almost 2.3 times higher for surgical services than that for medical services (70% vs. 30%). The triggers for RRS activation significantly differed between patient groups (P = 0.001). They included abnormal values for the respiratory rate (23.2%) and blood gas analysis (20.3%), and low blood pressure (18.8%) in the medical group; and low blood pressure (32.0%), low oxygen saturation (20.8%), and an abnormal heart rate (17.7%) in the surgical group. Patients were more likely classified as do not resuscitate or required intensive care unit admission in the medical group compared to those in the surgical group (65.3% vs. 54.7%, P = 0.045). In multivariate analysis, whether the patient belongs to medical services was found to be an independent predictor of mortality after adjusting for the modified early warning score, Charlson comorbidity index, and intervention performed by the RRS team. Our data suggest that RRS triggers, interventions, and outcomes greatly differ between patient groups. Further research is needed to evaluate the efficacy of an RRS approach tailored to specific patient groups.
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Affiliation(s)
- Yeon Joo Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Seon Lee
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunju Min
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Young Choi
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Young Lee
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Inae Song
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Sun Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jae Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangheon Park
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.
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