A rapid response system reduces the incidence of in-hospital postoperative cardiopulmonary arrest: a retrospective study

Abstract

Implementation of an RRS reduced the incidence of postoperative CPA in patients recovering in a general ward. Furthermore, this reduction was observed only during RRS operational hours.

Post‐operative alarm signs in the rapid response system and hospital mortality after non‐cardiac surgery

“…The data source was the Bundang Hospital Electronic System for Total Care (BESTCare), the electronic health record system of SNUBH. 18 Since the RRS was adopted by SNUBH in October 2012, 14,15 the present study set a learning period of 3 months, and reviewed the medical records of all patients who were admitted to SNUBH between January 2013 and June 2018 for non-cardiac surgery. If a single patient had undergone two or more surgeries during the study period, the repeat surgeries were excluded and only the first surgery was included in the analysis.…”

“…The RRS used in SNUBH is designed to automatically detect alarm signs based on vital signs and laboratory test results of inpatients in all wards, which are recorded and stored in electronic medical records (BESTCare, SNUBH, version 2.0, 2003). 14,15 When the RRS was established in SNUBH, intensivists chose 10 parameters as alarm criteria based on a previous report 16 : systolic blood pressure (SBP) <90 mm Hg, heart rate (HR) <50 or >140 bpm, respiratory rate (RR) <10 or >30/min, body temperature > 39°C or <36°C, SpO 2 <90%, pH <7.25, PaCO 2 >50 mm Hg, PO 2 <55 mm Hg, lactic acid >4 mmol/L, and total CO 2 <15 mmol/L. Abnormal vital signs detected by the RRS were checked by experienced nurses in the control station in order to rule out measurement errors and correct the alarm sign records, if needed.…”

“…14,15 There was no significant reduction in in-hospital mortality after RRS implementation. 14,15 The RRS is activated when laboratory test results or vital signs meet pre-defined triggering criteria. 16 Alarm signs detected by the RRS suggest worsening of the patient's condition and may be associated with increased in-hospital mortality in ward patients.…”

“…Our hospital, the Seoul National University Bundang Hospital (SNUBH), adopted a single‐parameter RRS in October 2012. We recently reported a reduction in the overall incidence of CPA as well as in the incidence of CPA among patients who underwent surgery 14,15 . There was no significant reduction in in‐hospital mortality after RRS implementation 14,15 .…”

Implementation of the rapid response system in the acute care ecosystem

“…(12) Over the years, various studies also provided sound evidence of clinical outcome improvement after the implementation of RRS. (13,14) However, some studies proved otherwise. (15,16) In particular, two major randomised trials involving RRS -the MERIT (Medical Early Response, Intervention and Therapy) trial (17) and the EPOCH trial on the effect of a paediatric early warning system on all-cause mortality in hospitalised paediatric patients (18) (with important limitations) -failed to demonstrate benefits based on the endpoints of death, unexpected cardiac arrests and unplanned ICU admissions.…”