Successful Implementation of a Rapid Response System in the Department of Internal Medicine
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Background: A rapid response system (RRS) aims to prevent unexpected patient death due to clinical errors and is becoming an essential part of intensive care. We examined the activity and outcomes of RRS for patients admitted to our institution’s department of internal medicine. Methods: We retrospectively reviewed patients detected by the RRS and admitted to the medical intensive care unit (MICU) from October 2012 through August 2013. We studied the overall activity of the RRS and compared patient outcomes between those admitted via the RRS and those admitted conventionally. Results: A total of 4,849 alert lists were generated from 2,505 medical service patients. The RRS was activated in 58 patients: A (Admit to ICU), B (Borderline intervention), C (Consultation), and D (Do not resuscitate) in 26 (44.8%), 21 (36.2%), 4 (6.9%), and 7 (12.1%) patients, respectively. Low oxygen saturation was the most common criterion for RRS activation. MICU admission via the RRS resulted in a shorter ICU stay than that via conventional admission (6.2 vs. 9.9 days, p = 0.018). Conclusions: An RRS can be successfully implemented in medical services. ICU admission via the RRS resulted in a shorter ICU stay than that via conventional admission. Further study is required to determine long-term outcomes.
Abstract
Background: A rapid response system (RRS) aims to prevent unexpected patient death due to clinical errors and is becoming an essential part of intensive care. We examined the activity and outcomes of RRS for patients admitted to our institution’s department of internal medicine. Methods: We retrospectively reviewed patients detected by the RRS and admitted to the medical intensive care unit (MICU) from October 2012 through August 2013. We studied the overall activity of the RRS and compared patient outcomes between those admitted via the RRS and those admitted conventionally. Results: A total of 4,849 alert lists were generated from 2,505 medical service patients. The RRS was activated in 58 patients: A (Admit to ICU), B (Borderline intervention), C (Consultation), and D (Do not resuscitate) in 26 (44.8%), 21 (36.2%), 4 (6.9%), and 7 (12.1%) patients, respectively. Low oxygen saturation was the most common criterion for RRS activation. MICU admission via the RRS resulted in a shorter ICU stay than that via conventional admission (6.2 vs. 9.9 days, p = 0.018). Conclusions: An RRS can be successfully implemented in medical services. ICU admission via the RRS resulted in a shorter ICU stay than that via conventional admission. Further study is required to determine long-term outcomes.
참고문헌 (20)
- Schein RM, "Clinical antecedents to in-hospital cardiopulmonary arrest", Chest, 98, pp.1388~1392 (1990)
- Kause J, "A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study", Resuscitation, 62, pp.275~282 (2004)
- Steel AC, "The growth of rapid response systems", Jt Comm J Qual Patient Saf, 34, pp.489~495 (2008)
- Devita MA, "Findings of the first consensus conference on medical emergency teams", Crit Care Med, 34, pp.2463~2478 (2006)
- Chan PS, "Rapid Response Teams: A Systematic Review and Meta-analysis", Arch Intern Med, 170, pp.18~26 (2010)
- Young MP, "Inpatient transfers to the intensive care unit: delays are associated with increased mortality and morbidity", J Gen Intern Med, 18, pp.77~83 (2003)
- Goldhill DR, "Outcome of intensive care patients in a group of British intensive care units", Crit Care Med, 26, pp.1337~1345 (1998)
- McGloin H, "Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable?", J R Coll Physicians Lond, 33, pp.255~259 (1999)
- Escarce JJ, "Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score", JAMA, 264, pp.2389~2394 (1990)
- Randy S. Wax, "Designing, implementing, and enhancing a rapid response system", pp.31~40 (2009), Society of Critical Care Medicine
- Franklin C, "Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event", Crit Care Med, 22, pp.244~247 (1994)
- Weissman C, "Analyzing intensive care unit length of stay data:problems and possible solutions", Crit Care Med, 25, pp.1594~1600 (1997)
- Wong DT, "Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit", Crit Care Med, 27, pp.1319~1324 (1999)
- Miller RS, "Outcomes of trauma patients who survive prolonged lengths of stay in the intensive care unit", J Trauma, 48, pp.229~234 (2000)
- Gilio AE, "Risk factors for nosocomial infections in a critically ill pediatric population: a 25-month prospective cohort study", Infect Control Hosp Epidemiol, 21, pp.340~342 (2000)
- Knaus WA, "Variations in mortality and length of stay in intensive care units", Ann Intern Med, 118, pp.753~761 (1993)
- Rapoport J, "A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study", Crit Care Med, 22, pp.1385~1391 (1994)
- Eagle KA, "Length of stay in the intensive care unit. Effects of practice guidelines and feedback", JAMA, 264, pp.992~997 (1990)
- Bellomo R, "Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates", Crit Care Med, 32, pp.916~921 (2004)
- Dacey MJ, "The effect of a rapid response team on major clinical outcome measures in a community hospital", Crit Care Med, 35, pp.2076~2082 (2007)