Features of the triggering of the yellow code and factors associated with the occurrence of adverse events / Características de la activación del código amarillo y factores relacionados a la ocurrencia de eventos adversos / Características do acionamento do código amarelo e fatores associados à ocorrência de eventos adversos

ABSTRACT Objective: to analyze the characteristics of the activation of the yellow code in wards and identify the factors associated with adverse events after the Rapid Response Team. Methods: a cross-sectional study with retrospective analysis of medical records of adults admitted to medical or surgical clinic wards of the University Hospital of São Paulo. Results: among the 91 patients, the most frequent signs of triggers (n=107) were peripheral oxygen saturation of less than 90% (40.2%) and hypotension (30.8%). Regarding the associated factors the research identified each minute of attendance of the Rapid Response Team in the wards increased by 1.2% odds of adverse events (twenty-four unplanned admission in the ICU and one cardiac arrest) in the sample (p=0.014). Conclusions: decreased oxygen saturation and hypotension were the main reasons for the triggering, and the length of care was associated with the frequency of adverse events.

RESUMEN Objetivo: analizar características de la activación del código amarillo en unidades de internación e identificar factores relacionados a ocurrencia de eventos adversos después de la atención del Equipo de Respuesta Rápida. Métodos: estudio transversal con análisis retrospectivo de prontuarios de adultos internados en enfermerías de Clínica Médica o Quirúrgica de hospital universitario de São Paulo. Resultados: entre 91 pacientes, los signos más frecuentes de las activaciones (n=107) fueron saturación periférica de oxígeno inferior a 90% (40,2%) y hipotensión arterial (30,8%). Cuanto a factores relacionados, identificado que cada minuto de atención del Equipo de Respuesta Rápida en enfermerías aumentó en 1,2% la chance de ocurrencia de eventos adversos (24 admisiones no planeadas en Unidad de Cuidado Intensivo y un paro cardíaco) en la amuestra (p=0,014). Conclusiones: caída de saturación de oxígeno e hipotensión arterial fueron los principales motivos de activación, y tiempo de ateción fue relacionado a ocurrencia de eventos adversos.

RESUMO Objetivo: analisar as características do acionamento do código amarelo em unidades de internação e identificar os fatores associados à ocorrência de eventos adversos após o atendimento do Time de Resposta Rápida. Métodos: estudo transversal com análise retrospectiva de prontuários de adultos internados em enfermarias de Clínica Médica ou Cirúrgica de hospital universitário de São Paulo. Resultados: entre os 91 pacientes, os sinais mais frequentes dos acionamentos (n=107) foram saturação periférica de oxigênio inferior a 90% (40,2%) e hipotensão arterial (30,8%). Quanto aos fatores associados, identificou-se que cada minuto de atendimento do Time de Resposta Rápida nas enfermarias aumentou em 1,2% a chance de ocorrência de eventos adversos (24 internações não planejadas em Unidade de Terapia Intensiva e uma parada cardiorrespiratória) na amostra (p=0,014). Conclusões: queda da saturação de oxigênio e hipotensão arterial foram os principais motivos de acionamento, e o tempo de atendimento foi associado à ocorrência de eventos adversos.

Documentação automatizada de parâmetros vitais em enfermarias utilizando estações portáteis - Efeito no acionamento adequado do time de resposta rápida: um protocolo de um ensaio clínico randomizado em clusters / Automated documentation of vital parameters in wards using portable stations - Effect on proper triggering of the rapid response team: a study protocol of a cluster randomized clinical trial

RESUMO Objetivo: Avaliar a eficácia da solução Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ em acionar o time de resposta rápida em tempo hábil, em comparação com o acionamento manual. Métodos: O estudo Hillrom é um ensaio clínico unicêntrico, aberto, de superioridade, randomizado em clusters em paralelo (taxa de alocação 1:1) realizado em um hospital terciário. Serão incluídos dois grupos de três enfermarias com 28 leitos (um grupo intervenção e um grupo controle). As enfermarias serão distribuídas aleatoriamente para utilizar a solução automatizada Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ (grupo intervenção) ou para manter a rotina habitual (grupo controle) em relação ao acionamento do time de resposta rápida. O desfecho primário será o número absoluto de ocorrências de acionamento do time de resposta rápida em tempo hábil. Como desfechos secundários, características clínicas como mortalidade, parada cardíaca, necessidade de internação em unidade de terapia intensiva e duração da hospitalização serão avaliadas de forma exploratória de acordo com os grupos. Estimou-se uma amostra de 216 acionamentos de time de resposta rápida, para identificar uma possível diferença entre os grupos. O protocolo foi aprovado pelo Comitê de Ética em Pesquisa institucional. Resultados esperados: Espera-se que a solução automatizada Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ seja mais eficaz no acionamento do sistema de chamada de enfermeiros, para acionar o time de resposta rápida em tempo hábil e de maneira adequada, em comparação com o acionamento manual (prática habitual). ClinicalTrials.gov: NCT04648579

ABSTRACT Objective: To evaluate the effectiveness of the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ solution in activating the rapid response team in a timely manner compared to manual activation. Methods: The Hillrom study is a single-center, open-label, superiority, cluster-randomized, parallel-group (1:1 allocation ratio) clinical trial that will be conducted in a tertiary hospital. Two sets of three wards with 28 beds will be included (one as the intervention cluster and the other as the control). The wards will be randomly assigned to use the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution (intervention cluster) or to maintain the usual routine (control cluster) regarding rapid response team activation. The primary outcome will be the absolute number of episodes of rapid response team triggering in an appropriate time; as secondary outcomes, clinical features (mortality, cardiac arrest, need for intensive care unit admission and duration of hospitalization) will be assessed according to clusters in an exploratory way. A sample size of 216 rapid response team activations was estimated to identify a possible difference between the groups. The protocol has been approved by the institutional Research Ethics Committee. Expected results: The Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution is expected to be more effective in triggering the nurse call system to activate the rapid response team in a timely and adequate manner compared to manual triggering (usual practice). ClinicalTrials.gov: NCT04648579

Estructura y función de los equipos de respuesta rápida para la atención de adultos en contextos hospitalarios de alta complejidad: Revisión sistemática de alcance / Structure and roles of rapid response teams for adult care in high complexity hospitals: Scoping review

Resumen Introducción y objetivo: Una importante proporción de pacientes hospitalizados presenta deterioro clínico severo que puede terminar en eventos adversos, paro cardíaco no esperado, o muerte; para reducir su frecuencia y prevenir sus consecuencias se han creado los equipos de respuesta rápida (ERR). El objetivo de esta revisión de alcance es describir la conformación, funcionamiento y resultados de la implementación de los ERR en el contexto hospitalario, con énfasis en los servicios de cirugía ginecológica y atención obstetricia. Materiales y métodos: Se llevó a cabo una búsqueda en las bases de datos de literatura médica Medline vía Pubmed, Embase vía OVID, LILACS, Cochrane Library y Open Gray. Se incluyeron estudios observacionales descriptivos y analíticos, estudios experimentales y estudios cualitativos que incluyeron ERR en instituciones de salud de alta complejidad u hospitales universitarios. Dos investigadores seleccionaron los estudios y extrajeron los datos respecto a la conformación, funcionamiento, los criterios de activación del equipo, los tiempos de respuesta o las herramientas de evaluación de su desempeño. No se hicieron restricciones de fecha o estado de publicación. Se incluyeron estudios en inglés, español y portugués. Se hace síntesis narrativa de los hallazgos. Resultados: La búsqueda arrojó 15,833 títulos, un total de 15 estudios cumplieron con los criterios de inclusión. Solo un estudio menciona el uso de los ERR en servicios de obstetricia. La conformación de los ERR es multidisciplinaria y están disponibles al menos 12 horas cada día. Sus funciones son la identificación temprana de pacientes con deterioro de la condición, especialmente en áreas por fuera de la unidad de cuidados intensivos y de pacientes con condiciones subyacentes o eventos desencadenantes que aumentan el riesgo de paro cardíaco. Además, implementan intervenciones rápidas multifacéticas que incluyen tratamientos farmacológicos, procedimientos cardiopulmonares, y desarrollan actividades de comunicación y formación. Se dispone de herramientas para la activación y evaluación de los procesos asistenciales. Conclusión: La estructura y las funciones del ERR están claramente descritas, lo que permite que sean ensamblados en hospitales de alta complejidad. Se deben realizar más investigaciones sobre los beneficios y riesgos del uso de los ERR para mitigar los daños en pacientes con EREND y comparar la efectividad y seguridad entre la activación de códigos y las estrategias de ERR en los servicios de obstetricia.

Abstract Introduction and Objective: A significant proportion of hospitalized patients experience severe clinical deterioration that may result in adverse events, unexpected cardiac arrest, or death. Rapid response teams (RRTs) have been created to reduce the frequency and prevent the consequences of these events. The objective of this scoping review is to describe the structure, role and results of the implementation of RRTs in the hospital context, with a focus on gynecological surgery and obstetric care. Materials and methods: A search was conducted in the Medline via Pubmed, Embase via OVID, LILACS, Cochrane Library and Open Gray medical databases. The search included descriptive and analytical observational studies, experimental studies and qualitative studies that included RRTs in high complexity healthcare institutions or teaching hospitals. Two researchers selected the studies and extracted data pertaining to the structure, roles and team activation criteria, response times or tools to assess their performance. No date or publication status restrictions were applied. Studies in English, Spanish and Portuguese were included. A narrative synthesis of the findings is made. Results: Overall, 15,833 titles were retrieved, of which 15 studies met the inclusion criteria. Only one study mentions the use of RRTs in obstetric services. RRTs have a multidisciplinary structure and they must be available at least 12 hours a day. The roles of RRTs include identification of patients who are deteriorating, especially outside the intensive care setting, and of patients with underlying conditions or triggering events that increase the risk of cardiac arrest. In addition, they implement rapid multifaceted interventions that include pharmacological treatments, cardiopulmonary procedures, and they develop communication and training activities. Tools for team activation and care process assessment are available. Conclusion: The structure and roles of RRTs are clearly described, making it possible to assemble them in high complexity hospitals. Further research is required to explore risks and benefits of using RRTs to mitigate harm in patients with adverse events and to compare effectiveness and safety between code activation and RRT strategies in obstetrics services.

Modificações no perfil de paradas cardíacas após implantação de um Time de Resposta Rápida / Changes in cardiac arrest profiles after the implementation of a Rapid Response Team

RESUMO Objetivo: Avaliar as modificações nas características das paradas cardíacas no hospital após a implantação de um Time de Resposta Rápida. Métodos: Este foi um estudo observacional prospectivo de paradas cardíacas ocorridas no hospital entre janeiro de 2013 e dezembro de 2017. O critério de exclusão foi parada cardíaca na unidade de terapia intensiva, na emergência ou na sala cirúrgica. O Time de Resposta Rápida foi introduzido no hospital do estudo em julho de 2014. Os pacientes foram classificados em dois grupos: Pré-Time de Resposta Rápida (parada cardíaca no hospital antes da implantação do Time de Resposta Rápida) e Pós- Time de Resposta Rápida (parada cardíaca no hospital após a implantação do Time de Resposta Rápida). Os pacientes foram seguidos até a alta hospitalar ou óbito. Resultados: Ocorreram 308 paradas cardíacas (64,6 ± 15,2 anos; 60,3% homens; 13,9% com ritmo inicial chocável). Houve diminuição de 4,2 para 2,5 no índice de parada cardíaca no hospital por 1.000 admissões após o início da atuação do Time de Resposta Rápida, além de cerca de 124 chamados por 1.000 admissões. A parada antes da implantação do Time de Resposta Rápida se associou com hipóxia (29,4 versus 14,3%; p = 0,006) e alteração da frequência respiratória (14,7 versus 4,2%; p = 0,004) em comparação aos dados referentes à parada cardíaca após a implantação do Time de Resposta Rápida. Parada cardíaca por hipóxia foi mais comum antes da implantação do Time de Resposta Rápida (61,2 versus 38,1%; p < 0,001). Na análise multivariada, o retorno à circulação espontânea se associou com ritmo chocável (RC 2,97; IC95% 1,04 - 8,43) e parada cardíaca testemunhada (RC 2,52; IC95% 1,39 - 4,59) mas não com a implantação do Time de Resposta Rápida (RC 1,40; IC95% 0,70 - 2,81) ou sinais premonitórios (RC 0,71; IC95% 0,39 - 1,28). Na análise multivariada, a mortalidade hospitalar se associou com ritmo não chocável (RC 5,34; IC95% 2,28 - 12,53) e idade (RC 1,03; IC95% 1,01 - 1,05), porém não com a implantação do Time de Resposta Rápida (RC 0,89; IC95% 0,40 - 2,02). Conclusão: Apesar de a implantação de um Time de Resposta Rápida se associar com redução na incidência de parada cardíaca no hospital, ela não se associou com a redução da mortalidade das vítimas de parada cardíaca no hospital. Observou-se significante diminuição nas paradas cardíacas devidas a causas respiratórias após a implantação do Time de Resposta Rápida.

ABSTRACT Objective: To evaluate changes in the characteristics of in-hospital cardiac arrest after the implementation of a Rapid Response Team. Methods: This was a prospective observational study of in-hospital cardiac arrest that occurred from January 2013 to December 2017. The exclusion criterion was in-hospital cardiac arrest in the intensive care unit, emergency room or operating room. The Rapid Response Team was implemented in July 2014 in the study hospital. Patients were classified into two groups: a Pre-Rapid Response Team (in-hospital cardiac arrest before Rapid Response Team implementation) and a Post-Rapid Response Team (in-hospital cardiac arrest after Rapid Response Team implementation). Patients were followed until hospital discharge or death. Results: We had a total of 308 cardiac arrests (64.6 ± 15.2 years, 60.3% men, 13.9% with initial shockable rhythm). There was a decrease from 4.2 to 2.5 in-hospital cardiac arrest/1000 admissions after implementation of the Rapid Response Team, and we had approximately 124 calls/1000 admissions. Pre-Rapid Response Team cardiac arrest was associated with more hypoxia (29.4 versus 14.3%; p = 0.006) and an altered respiratory rate (14.7 versus 4.2%; p = 0.004) compared with post-Rapid Response Team cardiac arrest. Cardiac arrest due to hypoxia was more common before Rapid Response Team implementation (61.2 versus 38.1%, p < 0.001). In multivariate analysis, return of spontaneous circulation was associated with shockable rhythm (OR 2.97; IC95% 1.04 - 8.43) and witnessed cardiac arrest (OR 2.52; IC95% 1.39 - 4.59) but not with Rapid Response Team implementation (OR 1.40; IC95% 0.70 - 2.81) or premonitory signs (OR 0.71; IC95% 0.39 - 1.28). In multivariate analysis, in-hospital mortality was associated with non-shockable rhythm (OR 5.34; IC95% 2.28 - 12.53) and age (OR 1.03; IC95% 1.01 - 1.05) but not with Rapid Response Team implementation (OR 0.89; IC95% 0.40 - 2.02). Conclusion: Even though Rapid Response Team implementation is associated with a reduction in in-hospital cardiac arrest, it was not associated with the mortality of in-hospital cardiac arrest victims. A significant decrease in cardiac arrests due to respiratory causes was noted after Rapid Response Team implementation.

Equipos de trauma: realidad mundial e implementación en un país en desarrollo. Descripción narrativa / Trauma teams: global reality and implementation in a developing country. Narrative description

Introducción. El trauma es una de las entidades con mayor morbimortalidad en el mundo. Los equipos especializados en la atención del paciente traumatizado son llamados «equipos de trauma¼. Dichos equipos surgieron de la necesidad de brindar tratamiento oportuno multidisciplinario a individuos con heridas que condicionan gran severidad en la guerra; sin embargo, con el paso del tiempo se trasladaron al ámbito civil, generando un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. El objetivo de este estudio fue describir el proceso de desarrollo de los equipos de trauma a nivel mundial y la experiencia en nuestra institución en el suroccidente colombiano. Métodos. Se realizó una búsqueda en la base de datos PUBMED, que incluyó revisiones sistemáticas, metaanálisis, revisiones de Cochrane, ensayos clínicos y series de casos. Resultados. Se incluyeron 41 estudios para esta revisión narrativa, y se observó que el tiempo de permanencia en Emergencias, el tiempo de traslado a cirugía, la mortalidad y las complicaciones asociadas al trauma fueron menores cuando se implementan equipos de trauma. Discusión. El diseño de un sistema de atención y valoración horizontal de un paciente con traumatismos severos produce un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. Se hace necesario establecer los parámetros operativos necesarios en las instituciones de salud de alta y mediana complejidad en nuestro país para implementar dichos equipos de trabajo

Introduction. Trauma is one of the entities with the highest morbidity and mortality in the world. Teams specialized in trauma patient care are called «trauma teams¼. These teams arose from the need to provide timely multidisciplinary treatment to individuals with severe injuries in war; however, with time they moved to the civilian arena, generating a positive impact in terms of care times, mortality and morbidity. The objective of this study was to describe the process of development of trauma teams worldwide and the experience in our institution in southwestern Colombia. Methods. A search of the PUBMED database was carried out, which included systematic reviews, metaanalyses, Cochrane reviews, clinical trials, and case series.Results. Forty-one studies were included for this narrative review, and it was observed that the length of stay in the ER, the time of transfer to surgery, mortality and complications associated with trauma were lower when trauma teams are implemented. Discussion. The design of a horizontal care and assessment system for a patient with severe trauma produces a positive impact in terms of care times, mortality and morbidity. It is necessary to establish operational parameters in high and medium complexity health institutions in our country to implement such work teams

Role of ski injury treatment system between the ski resort medical station of Winter Olympics and the nearby medical care hospital / 北京大学学报(医学版)

OBJECTIVE@#To make a retrospective analysis of the situation and process of treating skiers' injuries in the medical station of the Wanlong ski resort in Chongli and the nearest treatment hospital, and to provide a basis for the establishment and optimization of the treatment process between the medical station of the Winter Olympics ski resort and the nearest treatment hospital, and to gain experience for medical security of mass skiing.@*METHODS@#The data of all ski injuries in Chongli District were collected from the medical station of the Wanlong ski resort during the 2018-2019 snow season (November 2018 to April 2019) and the nearest treatment hospital during two periods (March 2019, and November 2019 to January 2020). The differences of injury causes, injury types, injury sites, and treatment effects of the injured skiers were analyzed.@*RESULTS@#A total of 755 cases of ski injuries were recorded in the medical station of Wanlong ski resort, the estimated incidence of injury was 2.02‰ per day. The nearest treatment hospital treated a total of 838 injured skiers from different ski resorts in Chongli District in the two periods. In the records of the ski resort medical station, the main causes of injury were technical defects and turnovers (53.6%). Knee joint injury rate was the highest (18.7%), followed by head and neck (12.9%) and lower limb (11.9%). The number of injuries on intermediate roads was the highest (40.0%), the greatest number of injuries (81.2%) occurred when the age of skiing was less than 5 years. In the records of the nearest treatment hospital, the injury types were fracture or fissure fracture, contusion and trauma, and muscle and soft tissue injury, accounting for 30.5%, 27.4%, and 21.2% respectively. 9.6% of the injured took the snow field ambulance to the hospital, and 50% of them suffered from fractures or fissure fractures.@*CONCLUSION@#The injury rate of skiing in the 2018-2019 snow season of the Wanlong ski resort in Chongli was higher than that reported by foreign literature. Severe trauma (including severe fractures and concussions) could occur and patients needed to be transferred to the nearest hospital for treatment. The ski resort medical station and the nearest treatment hospital should be strengthened with adequate medical staff and equipment, and promote cooperation in the timely referral of seriously injured patients, the organization and construction of ski patrols and the medical security of large-scale competitions, thus playing an important role in forming a grassroots network of medical security and treatment system for skiing.

Hospital cardioprotegido, antípoda de la muerte súbita: Propuesta del Hospital General de Cienfuegos / Cardio-protected hospital, antithesis of sudden death: A proposal of the Hospital General de Cienfuegos

RESUMEN Los problemas de muerte súbita y reanimación cardiopulmocerebral intrahospitalarias pueden tener estructurada una respuesta común; sin embargo, en la mayoría de los hospitales no se dispone de una estrategia orientada a su solución. Este trabajo actualiza sobre las principales alternativas para reducir la letalidad por muerte súbita intrahospitalaria y presenta una propuesta del Hospital General de Cienfuegos. El abordaje institucional para mayor supervivencia y menor discapacidad ante la muerte súbita dependerá de iniciativas multidisciplinarias enfocadas a la calidad y prevención, en los diferentes eslabones, de la reanimación cardiopulmocerebral. Un hospital cardioprotegido integra procesos gerenciales, organizativos, asistenciales, académicos y logísticos para todos los eslabones de la cadena de supervivencia ante una emergencia médica, principalmente la parada cardíaca súbita. La propuesta del Hospital General de Cienfuegos como institución cardioprotegida agrupa todos los elementos de un sistema integrado de reanimación cardiopulmocerebral enfocado hacia la calidad, seguridad y satisfacción de pacientes y prestadores.

ABSTRACT In-hospital sudden death and cardiopulmonary cerebral resuscitation problems could have a common structured response. However, most hospitals lack a solution-oriented strategy. This paper provides detailed update on the main alternatives to reduce lethality of in-hospital sudden death and presents a proposal from the "Hospital General de Cienfuegos". The institutional approach for greater survival and lesser disability when facing sudden death will be based on multidisciplinary initiatives primarily centered on quality and prevention in the different stages of cardiopulmonary cerebral resuscitation. A cardio-protected hospital comprises management, organizational, assistance, academic and logistical processes for every single link of the survival chain in a medical emergency event, mainly sudden cardiac arrest. The proposal of the "Hospital General de Cienfuegos", a cardio-protected facility, brings together all elements of an integrated cardiopulmonary cerebral resuscitation system aimed at quality, safety and satisfaction of patients and caregivers.

Critical incidents as perceived by rapid response teams in emergency services / Incidentes críticos percibidos por los equipos de respuesta rápida en atención de emergência / Incidentes críticos percebidos pelos times de resposta rápida nos atendimentos de emergência

Abstract Objective: To analyze two hospital emergency services, one in a public institution and another in a philanthropic one, from the perspective of rapid response team professionals in the face of positive and negative critical incidents. Method: Descriptive, exploratory, qualitative study carried with 62 health professionals. Critical Incident Technique was employed as the theoretical-methodological framework, along with Content Analysis for analyzing data. Results: Sixty-two health professionals - including 23 nurses, 20 physiotherapists and 19 doctors - took part in this study. Clusters for 89 critical incidents were obtained; 66 of them were considered positive, whereas 23 were negative. The situations associated to the provided services were discriminated in three categories: recognition of patient clinical deterioration; rapid response team activation in the unit; and time until rapid response team arrival at the ward. Conclusion: In spite of the difficulties faced by such professionals while providing care to patients who become severely ill in non-critical wards, positive reports were predominant in all categories, what legitimized this service's importance as a contribution to quality and safety of hospitalized patients.

Resumen Objetivo: Analizar las atenciones de emergencia en la perspectiva de los profesionales de los equipos de respuesta rápida en dos hospitales, siendo uno público y otro filantrópico, ante incidentes críticos positivos y negativos. Método: Estudio descriptivo, exploratorio, con abordaje cualitativo, realizado con 62 profesionales de salud. Se utilizó la Técnica del Incidente Crítico como propuesta teórico-metodológica y, para el análisis de los datos, el análisis de contenido. Resultados: Participaran 62 profesionales de salud, siendo 23 enfermeros, 20 fisioterapeutas y 19 médicos. Se obtuvo el agrupamiento de 89 incidentes críticos, siendo 66 considerados positivos y 23 negativos. Las situaciones relacionadas a las atenciones realizadas por los servicios fueron clasificadas en tres categorías, a saber: el reconocimiento del deterioro clínico del paciente; la activación del equipo de respuesta rápida en la unidad; y el tiempo de llegada del equipo de respuesta rápida al pabellón. Conclusión: Se destaca que, a pesar de las dificultades que enfrentan los profesionales durante la atención a pacientes que sufren deterioro en las unidades de cuidados no críticos, predominaran informes positivos en las tres categorías, que muestran la importancia del servicio como una contribución a la cualidad y seguridad de los pacientes hospitalizados.

Resumo Objetivo: Analisar os atendimentos de emergência na perspectiva dos profissionais dos times de resposta rápida em dois hospitais, sendo um público e um filantrópico, diante de incidentes críticos positivos e negativos. Método: Estudo descritivo, exploratório, de abordagem qualitativa, realizado com 62 profissionais de saúde. Utilizou-se a Técnica do Incidente Crítico como referencial teórico-metodológico e, para análise dos dados, a análise de conteúdo. Resultados: Participaram 62 profissionais de saúde, sendo 23 enfermeiros, 20 fisioterapeutas e 19 médicos. Obteve-se o agrupamento de 89 incidentes críticos, sendo 66 considerados positivos e 23 negativos. As situações relacionadas aos atendimentos realizados pelos serviços foram classificadas em três categorias, a saber: o reconhecimento da deterioração clínica do paciente; o acionamento do time de resposta rápida na unidade; e o tempo de chegada do time de resposta rápida à enfermaria. Conclusão: Destaca-se que, apesar das dificuldades enfrentadas por esses profissionais durante os atendimentos aos pacientes que se tornam graves nas unidades de internação não críticas, predominaram relatos positivos nas três categorias, que legitimaram a importância do serviço como contribuição à qualidade e segurança dos pacientes hospitalizados.

Implantação de um time de resposta rápida em um grande hospital filantrópico brasileiro: melhora na qualidade dos cuidados de emergência por meio do ciclo Planejar-Fazer-Estudar-Agir / Implementation of a rapid response team in a large nonprofit Brazilian hospital: improving the quality of emergency care through Plan-Do-Study-Act

RESUMO Objetivo: Descrever a implantação de um time de resposta rápida em um grande hospital filantrópico, indicando as questões relevantes para as iniciativas em contextos similares, particularmente na América Latina. Métodos: Em termos gerais, a intervenção consistiu em três componentes principais: (1) uma ferramenta para detecção de agravamento das condições clínicas nas enfermarias gerais; (2) estruturação de time de resposta rápida capaz de atender a todos os pacientes em risco; e (3) monitoramento dos indicadores relacionados à intervenção. Este trabalho empregou quatro ciclos semestrais (Planejar-Fazer-Estudar-Agir), com a finalidade de testar e ajustar a intervenção, entre janeiro de 2013 e dezembro de 2014. Resultados: Entre 2013 e 2014, o time de resposta rápida atendeu 2.296 pacientes. Houve redução não significante da mortalidade de 8,3% no ciclo 1, para 5,0% no ciclo 4; contudo, o número de óbitos permaneceu estável nos ciclos 3 e 4, com frequência de 5,2% e 5,0%, respectivamente. Com relação ao fluxo de pacientes e cuidados críticos continuados − uma premissa do time de resposta rápida −, houve decréscimo no tempo de espera por um leito na unidade de terapia intensiva, com diminuição de 45,9% para 19,0% na frequência de pacientes hospitalizados que não puderam ser imediatamente admitidos após a indicação (p < 0,001), representando melhora no fluxo de pacientes do hospital; ocorreu também aumento no reconhecimento de pacientes para cuidados paliativos, de 2,8% para 10,3% (p = 0,005). Conclusão: A implantação de um time de resposta rápida pode trazer benefícios nos contextos em que ocorrem restrições estruturais, como falta de leitos em unidades de terapia intensiva, porém há necessidade de alguns ajustes.

ABSTRACT Objective: To describe the implementation of a rapid response team in a large nonprofit hospital, indicating relevant issues for other initiatives in similar contexts, particularly in Latin America. Methods: In general terms, the intervention consisted of three major components: (1) a tool to detect aggravation of clinical conditions in general wards; (2) the structuring of a rapid response team to attend to all patients at risk; and (3) the monitoring of indicators regarding the intervention. This work employed four half-year Plan-Do-Study-Act cycles to test and adjust the intervention from January 2013 to December 2014. Results: Between 2013 and 2014, the rapid response team attended to 2,296 patients. This study showed a nonsignificant reduction in mortality from 8.3% in cycle 1 to 5.0% in cycle 4; however, death rates remained stable in cycles 3 and 4, with frequencies of 5.2% and 5.0%, respectively. Regarding patient flow and continuum of critical care, which is a premise of the rapid response system, there was a reduction in waiting time for intensive care unit beds with a decrease from 45.9% to 19.0% in the frequency of inpatients who could not be admitted immediately after indication (p < 0.001), representing improved patient flow in the hospital. In addition, an increase in the recognition of palliative care patients from 2.8% to 10.3% was noted (p = 0.005). Conclusion: Implementing a rapid response team in contexts where there are structural restrictions, such as lack of intensive care unit beds, may be very beneficial, but a strategy of adjustment is needed.

Características de los profesionales kinesiólogos y carga laboral: encuesta transversal de las Unidades de Cuidados Intensivos adulto en Chile / Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units

INTRODUCCIÓN: La Sociedad Europea de Medicina de Cuidados Intensivos recomienda la presencia de un Kinesiólogo con formación especializada, disponible cada cinco camas de alta complejidad, los 7 días de la semana en la Unidad de Cuidados Intensivos (UCI). En Chile se desconoce la adherencia de las UCI adulto a esta recomendación. OBJETIVO: Describir las características administrativas y de cobertura kinésica en las UCI adulto chilenas, y de acuerdo con la adherencia a las recomendaciones internacionales, informar a los tomadores de decisión en salud. MÉTODOS: Estudio observacional transversal, basado en encuesta telefónica. Se incluyeron las UCI adultos de establecimientos de mayor complejidad, clínicas privadas y centros asociados a universidades (n = 74). La proporción de instituciones con disponibilidad de kinesiólogos las 24 horas del día, los siete días de la semana (kinesiólogo 24/7), con un número máximo de cinco pacientes por kinesiólogo y presencia de un kinesiólogo especialista fueron reportados. RESULTADOS: La tasa de respuesta fue del 86,5% (n = 64), principalmente públicas (59%) y de nivel III (83%). El 70% (n = 45) de las UCI adulto chilenas cuentan con kinesiólogo 24/7; correspondiendo el 87% al sector público y el 46% al privado. El 41% de los centros posee un máximo de 5 pacientes por kinesiólogo en día hábil diurno, disminuyendo en fines de semana y horarios nocturnos. Un 23% de las UCIs cuenta con kinesiólogo especialista en intensivo, siendo mayor en el sector privado (31%). CONCLUSIONES: En UCI adulto chilenas, la disponibilidad de kinesiólogos 24/7 es alta, y la prevalencia de especialistas es baja. Estrategias de creación de programas de formación de especialidad podrían contribuir a disminuir la brecha de especialistas.

INTRODUCTION: The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown. OBJECTIVE: To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers. METHODS: Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist. RESULTS: Response rate was 86.5%, with 59% of responding units being public and 83% offering level III care. 70% of the adult Intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the Intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%). CONCLUSIONS: In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist training is low. Future efforts should focus on promoting the uptake of specialist training.

Evaluation of Medical Emergency Team Activation in Surgical Wards

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.

Alteración de signos vitales dentro de las 72 h previas a la activación de código azul en pacientes adultos hospitalizados de un hospital universitario / Deterioration of vital signs as predictors of major medical emergencies in hospitalized patients

Background: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. Aim: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. Patients and Methods: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. Results: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. Conclusions: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.

Equipo de respuesta rápida: ¿qué factores interfieren con su desempeño? / Equipe de resposta rápida: quais fatores interferem no seu desempenho? / Rapid response team: what factors interfere with your performance?

Objective. Describe the knowledge in the literature related to factors that influence the performance of response teams. Methods. Integrative review of the literature of articles published in Portuguese, English or Spanish between 2006 and 2016. The descriptors hospital rapid response equipment, cardiac arrest and hospital mortality were used for the search in the PubMed/Medline, Lilacs - Bireme and CINAHL bibliographic databases. Results. 19 studies were included for the analysis. The results were categorized in: sociocultural barriers and institutional policies, late activation of the rapid response team, composition and/or strengthening of the team's capacity, and use of facilitating tools. The sociocultural barriers found were: the presence of interprofessional hierarchies and beliefs, the limitations of institutional policies were related to the lack of training and human resources deficit. Late activations increased mortality, duration of hospitalization, and admission to the intensive care unit. The teams composed of intensive care professionals showed a reduction in mortality and in the occurrence of cardiac arrest. The use of new tools did not promote changes in the response of the team. Conclusion. The factors found in this review influence the performance of the rapid response team. The foregoing should be taken into account to improve the survival of patients who require this type of care. (AU)

Objetivo. Describir el conocimiento en la literatura relacionado con factores que influyen en el desempeño de equipos de respuesta. Métodos. Revisión integradora de la literatura de artículos publicados en portugués, inglés o español entre 2006 a 2016. Se emplearon los descriptores hospital equipo de respuesta rápida, paro cardíaco y mortalidad hospitalaria para la búsqueda en las bases bibliográficas PubMed/Medline, Lilacs ­ Bireme y CINAHL. Resultados. Se incluyeron para el análisis 19 estudios. Los resultados se categorizaron en: barreras socioculturales y políticas institucionales; activación tardía del equipo de respuesta rápida; composición y/o fortalecimiento de la capacidad del equipo; y uso de herramientas facilitadoras. Las barreras socioculturales encontradas fueron: presencia de creencias y jerarquías interprofesionales. Las limitaciones de las políticas institucionales se relacionaron con la falta de capacitación y déficit de recurso humano. Las activaciones tardías aumentaron la mortalidad, la duración de la hospitalización y el ingreso del paciente a la unidad de cuidados intensivos. Los equipos compuestos por profesionales de cuidados intensivos mostraron una reducción en la mortalidad y en la ocurrencia de paro cardíaco. El uso de nuevas herramientas no promovió cambios en la respuesta del equipo. Conclusión. Los factores encontrados en esta revisión influyen en el desempeño del equipo de respuesta rápida. Lo anterior debe tenerse en cuenta para mejorar la supervivencia de los pacientes que requieren este tipo de atención. (AU)

Objetivo. Descrever o conhecimento da literatura a respeito dos fatores que influenciam o desempenho das equipes de resposta. Métodos. Revisão integrativa da literatura de artigos publicados em português, inglês ou espanhol entre 2006 e 2016. Foram usados os descritores equipe de respostas rápidas de hospitais, parada cardíaca e mortalidade hospitalar para pesquisar nas bases de dados bibliográficas PubMed/Medline, Lilacs ­ Bireme e CINAHL. Resultados. Foram incluídos 19 estudos para a análise. Os resultados foram categorizados em: barreiras socioculturais e políticas institucionais; ativação tardia da equipe de resposta rápida; composição e/ou fortalecimento da capacidade da equipe; e uso de ferramentas facilitadoras. As barreiras socioculturais encontradas foram: presença de hierarquias e crenças interprofissionais. As limitações das políticas institucionais se relacionaram à falta de capacitação e déficit de recursos humanos. As ativações tardias aumentaram a mortalidade, a duração da hospitalização e internação em unidade de terapia intensiva. As equipes compostas por profissionais de terapia intensiva mostraram redução na mortalidade e na ocorrência de parada cardiorrespiratória. O uso de novas ferramentas não promoveu mudanças na resposta da equipe. Conclusão. Os fatores encontrados nesta revisão influenciam no desempenho da equipe de resposta rápida. Isso deve ser levado em conta para melhorar a sobrevida dos pacientes que necessitam desse tipo de cuidado (AU)

Identificación de gatillantes de sistema de respuesta rápida en pacientes de unidades de baja complejidad de un hospital universitario / Identification of rapid response system triggers in unit patients of low complexity of a university hospital

Las complicaciones graves de pacientes en unidades de baja complejidad habitualmente son precedidas por alteración en los signos vitales. Los equipos de respuesta rápida (ERR) atienden precozmente a pacientes con alteración de signos vitales que se relacionan con resultados adversos. Nuestro objetivo es determinar la tasa de gatillantes de ERR en pacientes hospitalizados en unidades de baja complejidad y su eventual relación con eventos adversos posteriores. Métodos: Observación de registros de una cohorte prospectiva de pacientes mayores de 18 años en unidades de baja complejidad de un hospital universitario. Resultados: Se encontraron gatillantes en 50 de 1144 pacientes (4,4 por ciento). La edad promedio fue de 58 años, y 58 por ciento fueron mujeres. Los gatillantes más frecuentes fueron: Hipotensión (40 por ciento), frecuencia respiratoria mayor a 25 por minuto (26 por ciento) y Saturación de oxígeno menor a 90 por ciento (24 por ciento). Presentaron eventos adversos mayores 6 pacientes (12 por ciento), 1 de ellos con desenlace fatal y los 6 fueron trasladados a unidad de mayor complejidad. No existió diferencia significativa entre quienes tuvieron 1 o 2 gatillantes en relación a eventos adversos mayores. Los 3 pacientes que presentaron compromiso de conciencia sufrieron eventos adversos mayores incluyendo la muerte de uno. Conclusión: Los gatillantes más frecuentes fueron hipotensión y taquipnea. La presencia de dos eventos gatillantes muestra una tendencia a un peor resultado, si bien no alcanza significancia estadística. Dado nuestra eventual tasa de activación de ERR si se justificaría la implementación de estos equipos en nuestro medio.(AU)

Serious patient complications in low complexity units are usually preceded by impaired vital signs. Rapid Response Teams (RRT) treat patients with impaired vital signs that are related to early adverse outcomes. Our objective is to determine the ERR trigger rates in hospitalized patients in low complexity units and their eventual relationship with subsequent adverse events. Methods: Recorded observation of a cohort of prospective patients older than 18 years in a University hospital´s low complexity units. Results: 50 out of 1.144 patients (4.4 percent) were found to have triggers. The mean age was 58 years, and 58 percent were women. The most frequent triggers were: Hypotension (40 percent), respiratory rate greater than 25 per minute (26 percent) and oxygen saturation less than 90 percent (24 percent). Major adverse events were in six patients (12 percent), one of them had a fatal outcome and six patients were transferred to a more complex unit. There was no significant difference between those who had one or two triggers and the relation to their major adverse events. The three patients who had compromised consciousness experienced major adverse events including death to one of them. Conclusion: The most frequent triggers were hypotension and tachypnea. The presence of two triggering events shows a tendency to a worse result, although it does not reach statistical significance. Considering our RRT´s eventual activation rate, the implementation of RRT teams would be justified in our environment.(AU)

Puntaje predictivo de emergencias médicas en un servicio médico quirúrgico, usando variables clínicas y los diagnósticos de ingreso / A score to predict medical emergencies in hospitalized patients

Background: The medical alert system (MAS) was created for the timely handling of clinical decompensations, experienced by patients hospitalized at the Medical Surgical Service (MSS) in a private clinic. It is activated by the nurse when hemodynamic, respiratory, neurological, infectious or metabolic alterations appear, when a patient falls or complains of pain. A physician assesses the patient and decides further therapy. Aim: To analyze the clinical and demographic characteristics of patients who activated or not the MAS and develop a score to identify patients who will potentially activate MAS. Material and Methods: Data from 13,933 patients discharged from the clinic in a period of one year was analyzed. Results: MAS was activated by 472 patients (3.4%). Twenty two of these patients died during hospital stay compared to 68 patients who did not activate the alert (0.5%, p < 0.01). The predictive score developed considered age, diagnosis (based on the tenth international classification of diseases) and whether the patient was medical or surgical. The score ranges from 0 to 9 and a cutoff ≥ 6 provides a sensitivity and specificity of 37 and 81% respectively and a positive likelihood ratio (LR+) of 1.9 to predict the activation of MAS. The same cutoff value predicts death with a sensitivity and specificity of 80% and a negative predictive value of 99.8%. Conclusions: This score may be useful to identify hospitalized patients who may have complications during their hospital stay.

Atendimentos realizados por times de respostas rápidas em hospitais / Care by rapid response teams in hospitals

A segurança do paciente tornou-se indispensável para o sistema de saúde, portanto iniciativas vêm sendo implantadas, no decorrer dos anos, com vistas a reduzir os eventos adversos. A atuação do time de resposta rápida (TRR) consolida-se como estratégia para prover atendimento ao paciente que apresente sinais de deterioração clínica no setor de internação geral em hospitais. O serviço é formado por equipe multiprofissional capacitada para prestar tratamento intensivo ao paciente com quadro de deterioração clínica aguda no setor de internação, por meio de códigos (amarelo e azul) instituídos para seu acionamento, com vistas a reduzir a probabilidade de agravamento do quadro clínico ou risco de óbito imediato do paciente, durante o seu período de hospitalização. O estudo objetiva caracterizar as exigências críticas nos atendimentos emergenciais realizados por TRR, em um hospital público no estado do Paraná e um filantrópico no estado de São Paulo. Pesquisa descritiva, exploratória, qualitativa, com utilização da Técnica do Incidente Crítico como guia do processo metodológico, realizada por meio de entrevistas com 19 médicos, 20 fisioterapeutas e 23 enfermeiros. Os resultados encontrados foram agrupados em 89 incidentes críticos extraídos das entrevistas. A análise dos dados constou da identificação e do agrupamento de 220 comportamentos e 130 consequências. A partir das situações, comportamentos e consequências identificadas, destacam-se a necessidade da melhoria na via aferente do TRR (reconhecimento da deterioração clínica e acionamento do TRR na unidade), a capacitação dos profissionais das unidades de internação para exercer as habilidades técnicas iniciais necessárias frente ao atendimento de emergência até a chegada do TRR, a falha na interação entre os diversos profissionais durante o atendimento do código azul com prejuízo na sistematização do atendimento de emergência para reverter o quadro de parada cardiorrespiratória dos pacientes e os sentimentos e emoções negativas geradas nos profissionais como dificultadores dos atendimentos emergenciais em código azul. Em relação aos destaques positivos a partir das situações, comportamentos e consequências identificados, ressaltam-se o tempo de chegada do TRR na unidade para realizar o atendimento de emergência, a sistematização do atendimento de reanimação cardiopulmonar realizada pela equipe multiprofissional, o restabelecimento das funções vitais do paciente após o atendimento e a sua transferência após a finalização do atendimento da unidade de internação para um ambiente de cuidados intensivos. Como principais sugestões ao TRR, os entrevistados pontuaram a importância da capacitação de atendimento de emergência aos profissionais das unidades de internação, a necessidade de mantê-los atuando exclusivamente no TRR, o número adequado de profissionais no quarto durante o atendimento de emergência e a importância do registro em prontuário do paciente sobre a decisão de não reanimação frente aos cuidados paliativos. Destaca-se a expressiva frequência dos resultados positivos comparados aos negativos que permearam as situações, comportamentos e consequências decorrentes das entrevistas. Infere-se que mesmo ocorrendo dificuldades, enfrentadas por esses profissionais durante os atendimentos realizados aos pacientes que se tornam críticos nas enfermarias, predominaram os relatos positivos nas diversas categorias que legitimaram a importância da implantação desse serviço, como contribuição à qualidade e segurança dos que estão hospitalizados

Patient safety has become indispensable for the health system. Therefore, initiatives have been implemented over the years to reduce adverse events. The performance of the Rapid Response Team (RRT) has been consolidated as a strategy to provide care to patients who get in critical conditions at the general hospital admission unit. The service is constituted by a multiprofessional team with an approach in the intensive treatment of patients with signs of acute clinical deterioration in the inpatient unit, through codes established for its activation, in order to reduce the probability of worsening of the clinical condition or imminent death risk of the patient during the hospitalization period. The study aims to characterize the critical requirements in emergency care provided by the RRT at a public hospital in the state of Paraná and a philanthropic hospital in the state of São Paulo, Brazil. This is a descriptive, exploratory study with a qualitative approach, adopting the Critical Incident Technique to guide the methodological procedures, performed with 62 health professionals, being 19 physicians, 20 physiotherapists and 23 nurses. The results were grouped into 89 critical incidents extracted from the interviews. Data analysis consisted of the identification and grouping of 220 behaviors and 130 consequences. Based on the situations, behaviors and consequences identified, there is a need to improve the afferent pathway of RRT (recognition of clinical deterioration and activation of the RRT in the unit), the qualification of the professionals of the inpatient units to perform the necessary initial technical skills in the emergency response until the arrival of the RRT, the failure in the interaction among the different professionals during blue-code care with negative effects for the systematization of emergency care to revert the patients' CPA and the negative feelings and emotions generated in the professionals as impediments to code-blue emergency care. Regarding the positive highlights from the situations, behaviors and consequences identified, the arrival time of the RRT in the unit to perform the emergency care, the systematization of the cardiopulmonary resuscitation service performed by the multiprofessional team, the restoration of the patient's vital functions after the care and transfer of the patient after the end of the care from the inpatient unit to an intensive care environment. As the main suggestions to the RRT, the interviewees pointed out the importance of emergency care training for the professionals of the inpatient units, the need to keep the professionals working exclusively in the RRT, the appropriate number of professionals in the room during emergency care and the importance of registering the patient's decision not to reanimate in the patient file in view of palliative care. The significant frequency of positive over negative results was highlighted, which permeated the situations, behaviors and consequences deriving from the interviews. It is inferred that, even though these professionals encountered difficulties during the visits to patients who became critical in the wards, the positive reports predominated in the various categories that legitimized the importance of implementing this service, as a contribution to the quality and safety of hospitalized patients

Early Experience of Medical Alert System in a Rural Training Hospital: a Pilot Study / 대한구급학회지

BACKGROUND: Medical emergency teams (METs) have shown their merit in preventing unexpected cardiac arrest. However, it might be impractical for small- or medium-sized hospitals to operate an MET due to limited manpower and resources. In this study, we sought to evaluate the feasibility of a medical alert system (MAS) that alerts all doctors involved in patient care of patient deterioration via text message using smart-phones. METHODS: The MAS was test-operated from July 2015 to September 2015, in five general wards with a high incidence of cardiac arrest. The number of cardiac arrests was compared to that of 2014. The indication for activation of MAS was decided by the intensive care unit committee of the institution, which examined previous reports on MET. RESULTS: During the three-month study period, 2,322 patients were admitted to the participating wards. In all, MAS activation occurred in 9 patients (0.39%). After activation, 7 patients were admitted to the intensive care unit. Two patients (0.09%) experienced cardiac arrest. Of 13,129 patients admitted to the ward in 2014, there were 50 cases (0.38%) of cardiac arrest (p = 0.009). CONCLUSIONS: It is feasible to use MAS to prevent unexpected cardiac arrest in a general ward.

Early Experience of Medical Alert System in a Rural Training Hospital: a Pilot Study / 대한중환자의학회지

BACKGROUND: Medical emergency teams (METs) have shown their merit in preventing unexpected cardiac arrest. However, it might be impractical for small- or medium-sized hospitals to operate an MET due to limited manpower and resources. In this study, we sought to evaluate the feasibility of a medical alert system (MAS) that alerts all doctors involved in patient care of patient deterioration via text message using smart-phones. METHODS: The MAS was test-operated from July 2015 to September 2015, in five general wards with a high incidence of cardiac arrest. The number of cardiac arrests was compared to that of 2014. The indication for activation of MAS was decided by the intensive care unit committee of the institution, which examined previous reports on MET. RESULTS: During the three-month study period, 2,322 patients were admitted to the participating wards. In all, MAS activation occurred in 9 patients (0.39%). After activation, 7 patients were admitted to the intensive care unit. Two patients (0.09%) experienced cardiac arrest. Of 13,129 patients admitted to the ward in 2014, there were 50 cases (0.38%) of cardiac arrest (p = 0.009). CONCLUSIONS: It is feasible to use MAS to prevent unexpected cardiac arrest in a general ward.