ABSTRACT
PURPOSE: A review was performed to determine the frequency of activating medical emergency teams (MET) in surgical wards, so that resource allocation could be optimized.METHODS: A retrospective observational study was performed to determine the time and frequency when MET were deployed (N = 465) to patients (n = 387) who were admitted to the surgical ward, from March 2013 to July 2016 due to emergency situations.RESULTS: Of the 465 MET activations, 8 did not incur any further intervention. The review showed an average of 151 minutes from onset of symptoms to MET activation, and an average of 110 minutes until intervention (additional diagnosis / treatment). The number of MET activations increased year by year from 2013 to 2016. The transfer of patients to the intensive care units also increased from 34 in 2013, to 82 in 2016. The lowest number of MET activations occurred between 04:00 and 05:00, but there was no difference in the number of MET activations between day and night. However, MET activation in response to acute respiratory distress was significantly higher during the nighttime (p = 0.003).CONCLUSION: Patients admitted to a surgical ward have more serious complications. This study showed that the use of MET in surgical wards has increased year by year, and the frequency of calls between day and night was not different, except higher MET activations observed at night in patients with acute respiratory distress.
Subject(s)
Humans , Diagnosis , Emergencies , Hospital Mortality , Hospital Rapid Response Team , Intensive Care Units , Observational Study , Resource Allocation , Retrospective StudiesABSTRACT
BACKGROUND: Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest. The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs) and the current level of cardiopulmonary arrest rate in tertiary hospitals. METHODS: This was a retrospective study based on data from 14 tertiary hospitals. Cardiopulmonary resuscitation (CPR) rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present. RESULTS: Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009). Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854). National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001). High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001) and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001). CONCLUSIONS: RRSs may be a feasible option to reduce the CPR rate. The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics.
Subject(s)
Adult , Humans , Cardiopulmonary Resuscitation , Heart Arrest , Hospitals, High-Volume , Incidence , Motivation , Patient Safety , Patients' Rooms , Pilot Projects , Quality of Health Care , Retrospective Studies , Tertiary Care CentersABSTRACT
BACKGROUND: Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest. The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs) and the current level of cardiopulmonary arrest rate in tertiary hospitals. METHODS: This was a retrospective study based on data from 14 tertiary hospitals. Cardiopulmonary resuscitation (CPR) rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present. RESULTS: Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009). Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854). National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001). High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001) and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001). CONCLUSIONS: RRSs may be a feasible option to reduce the CPR rate. The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics.
Subject(s)
Adult , Humans , Cardiopulmonary Resuscitation , Heart Arrest , Hospitals, High-Volume , Incidence , Motivation , Patient Safety , Patients' Rooms , Pilot Projects , Quality of Health Care , Retrospective Studies , Tertiary Care CentersABSTRACT
Rapid Response Systems have been introduced in the last decade to increase patient safety and decrease the rate of cardiorespiratory arrest on the hospital wards and readmission to the intensive care units. In this article we share our experience at the Hospital for Sick Children in Toronto on implementation and evolution of a pediatric rapid response team; the process, barriers, and ongoing challenges.
ABSTRACT
Aims: Description of a study protocol to analyze the effectiveness of the sequential implementation of a Rapid Response System (RRS) on the incidence of the composite endpoint of cardiac arrest, unplanned ICU admission, and mortality rates. Study Design: The COMET trial is a before-after, non-randomized multi-center trial. Place and Duration of Study: The COMET trial was held in the Netherlands in fourteen Dutch hospitals from April 2009 until November 2011. Each hospital included two surgical and two general medicine nursing wards. Methodology: Prior to the introduction of the RRS, endpoints were collected for 5 months as part of a baseline assessment. The RRS was introduced in two steps. Initially, two tools were introduced during 7 months for early detection of the deteriorating patient: the Modified Early Warning Score (MEWS) and for structured communication, the Situation-Background-Assessment-Recommendation (SBAR) tool. During the next 15 months the Rapid Response Team (RRT) was operational in addition to both the detection and communication tool. Generalized Estimating Equations (GEE) analysis of trends in outcomes will be performed. The cost description will primarily focus on the program costs associated with training and education sessions and the time invested in all consultations originating from patient care on the study wards. Conclusion: The COMET study will provide evidence on the clinical outcomes and costs of the implementation of Rapid Response System. This will include an analysis to explore the possible effect of a Rapid Response Team as add-on to the MEWS and SBAR tools for early recognition of the deteriorating patient on the nursing ward.