Differences in the Clinical Characteristics of Rapid Response System Activation in Patients Admitted to Medical or Surgical Services

Lee, Yeon Joo; Lee, Dong-Seon; Min, Hyunju; Choi, Yun Young; Lee, Eun Young; Song, In-Ae; Cho, Goo-Yeong; Kim, Jin Won; Cho, Young Jae; Lee, Jae Hyuk; Suh, Jung Won; Jo, You Hwan; Kim, Kyuseok; Park, Sangheon

doi:10.3346/jkms.2017.32.4.688

Cited by 15 publications

(18 citation statements)

References 25 publications

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“…As care factors, medical patients tended to have worse outcomes than did surgical patients. This finding was similar to previous findings (Lee et al, 2017 showing that patients with interventions by rapid response teams had higher mortality (Lee et al, 2017;Tirkkonen, Tamminen, & Skrifvars, 2017). These findings may indicate that appropriate, timely management at ICU/HDB and operating room, without escalated care or rapid response team activation, resulted in better outcome.…”

Section: Discussionsupporting

confidence: 90%

“…In Korea, there are presently no nationally recommended early warning scoring systems, or even guidelines regarding the implementation of a rapid response system. Korean hospitals have operated rapid response systems using locally developed multiple clinical parameters (Kwak et al, 2014;Lee et al, 2017). Prior research has shown that aggregate weighted early warning scoring systems were better at predicting clinical deterioration than early warning scoring systems based on single or multiple parameters (Churpek, Yuen, & Edelson, 2013;McNeill & Bryden, 2013).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…This hospital was accredited as having a Stage 7 comprehensive electronic health record (EHR) system by the Healthcare Information and Management Systems Society. The hospital implemented a hospital-wide rapid response system in October 2010 (Lee et al, 2017). The nurse staffing level in general wards was Grade 1 (<2.0 patients per nurse).…”

Section: Study Setting and Samplementioning

confidence: 99%

“…In Korea, several hospitals have locally adopted early warning systems that are also known as rapid response systems (Kim et al, 2015;Lee, Choi, et al, 2018;Lee et al, 2017). More recently, the Korean government has announced formal reimbursement from the National Health Insurance regarding the implementation of a rapid response system in hospitals in order to encourage and support rapid implementation of this patient safety practice (Ministry of Health & Welfare, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Relationships between the National Early Warning Score 2, clinical worry and patient outcome at discharge: Retrospective observational study

Hwang

Chin

2020

Journal of Clinical Nursing

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Aims and objectives To examine the performance of the National Early Warning Score 2 and composite score for clinical worry in identifying patients at risk of clinical deterioration, and to determine relationships between National Early Warning Score 2, clinical worry score and patient outcome at discharge. Background The efficacy of early warning systems depends on patient population and care settings. Based on a theoretical framework on factors affecting clinical deterioration and patient outcomes, studies exploring the relationship between early warning systems and patient outcomes at discharge are sparse. Design Retrospective observational study. Methods A random sample of 732 medical records were reviewed. The area under the receiver operating characteristic curve was calculated to evaluate predictive abilities regarding the events of unanticipated in‐hospital mortality, unplanned intensive care unit/ higher dependency bed admission and cardiac arrest. Multiple logistic regression analyses were performed to determine relationships between National Early Warning Score 2, clinical worry score and patient outcome. Reporting followed the STROBE checklist. Results National Early Warning Score 2 and clinical worry score significantly predicted the events within 24 hr of the assessment. After controlling for other patient, treatment and organisational characteristics, National Early Warning Score 2 was a significant factor associated with patient outcome, but clinical worry score was not. Specifically, patients at high risk based on National Early Warning Score 2 were less likely to have improved outcome. Conclusions National Early Warning Score 2 and clinical worry score performed well for predicting deteriorating condition of patients. National Early Warning Score 2 was significantly associated with patient outcome. It can be used for efficient patient management for safe, quality care. Relevance to clinical practice National Early Warning Score 2 can be used for early assessment of not only clinical deterioration but also patient outcome and provide timely intervention, when coupled with clinical worry score.

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Section: Discussionsupporting

confidence: 90%

Section: Backg Rou N Dmentioning

confidence: 99%

Section: Study Setting and Samplementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationships between the National Early Warning Score 2, clinical worry and patient outcome at discharge: Retrospective observational study

Hwang

Chin

2020

Journal of Clinical Nursing

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“…Accordingly, new models with additional factors such as lactic acid or d-dimer levels, which have not been included in traditional EWS models, have been developed and validated to improve accuracy according to targeted patient groups [ 8 , 9 ]. There is also a need for tailored EWS models to ensure practical usefulness in the respiratory wards [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the SpO2/FiO2 ratio as a predictor of intensive care unit transfers in respiratory ward patients for whom the rapid response system has been activated

et al. 2018

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Efforts to detect patient deterioration early have led to the development of early warning score (EWS) models. However, these models are disease-nonspecific and have shown variable accuracy in predicting unexpected critical events. Here, we propose a simpler and more accurate method for predicting risk in respiratory ward patients. This retrospective study analyzed adult patients who were admitted to the respiratory ward and detected using the rapid response system (RRS). Study outcomes included transfer to the intensive care unit (ICU) within 24 hours after RRS activation and in-hospital mortality. Prediction power of existing EWS models including Modified EWS (MEWS), National EWS (NEWS), and VitalPAC EWS (ViEWS) and SpO2/FiO2 (SF) ratio were compared to each other using the area under the receiver operating characteristic curve (AUROC). Overall, 456 patients were included; median age was 75 years (interquartile range: 65–80) and 344 (75.4%) were male. Seventy-three (16.0%) and 79 (17.3%) patients were transferred to the ICU and died. The SF ratio displayed better or comparable predictive accuracy for unexpected ICU transfer (AUROC: 0.744) compared to MEWS (0.744 vs. 0.653, P = 0.03), NEWS (0.744 vs. 0.667, P = 0.04), and ViEWS (0.744 vs. 0.675, P = 0.06). For in-hospital mortality, although there was no statistical difference, the AUROC of the SF ratio (0.660) was higher than that of each of the preexisting EWS models. In comparison with the preexisting EWS models, the SF ratio showed better or comparable predictive accuracy for unexpected ICU transfers in the respiratory wards.

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The characteristics, types of intervention, and outcomes of postoperative patients who required rapid response system intervention: a nationwide database analysis

et al. 2021

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Purpose Improving the safety of general wards is a key to reducing serious adverse events in the postoperative period. We investigated the characteristics, treatment, and outcomes of postoperative patients managed by a rapid response system (RRS) in Japan to improve postoperative management. Methods This retrospective study analyzed cases requiring RRS intervention that were included in the In-Hospital Emergency Registry in Japan. We analyzed data reported by 34 Japanese hospitals between January 2014 and March 2018, mainly focusing on postoperative patients for whom the RRS was activated within 7 days of surgery. Non-postoperative patients, for whom the RRS was activated in all other settings, were used for comparison as necessary. Results There were 609 (12.7%) postoperative patients among the total patients in the registry. The major criteria were staff concerns (30.2%) and low oxygen saturation (29.7%). Hypotension, tachycardia, and inability to contact physicians were observed as triggers significantly more frequently in postoperative patients when compared with non-postoperative patients. Among RRS activations within 7 days of surgery, 68.9% of activations occurred within postoperative day 3. The ordering of tests (46.8%) and fluid bolus (34.6%) were major interventions that were performed significantly more frequently in postoperative patients when compared with non-postoperative patients. The rate of RRS activations resulting in ICU care was 32.8%. The mortality rate at 1 month was 16.2%. Conclusion Approximately, 70% of the RRS activations occurred within postoperative day 3. Circulatory problems were a more frequent cause of RRS activation in the postoperative group than in the non-postoperative group.

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Differences in the Clinical Characteristics of Rapid Response System Activation in Patients Admitted to Medical or Surgical Services

Cited by 15 publications

References 25 publications

Relationships between the National Early Warning Score 2, clinical worry and patient outcome at discharge: Retrospective observational study

Relationships between the National Early Warning Score 2, clinical worry and patient outcome at discharge: Retrospective observational study

Evaluation of the SpO2/FiO2 ratio as a predictor of intensive care unit transfers in respiratory ward patients for whom the rapid response system has been activated

The characteristics, types of intervention, and outcomes of postoperative patients who required rapid response system intervention: a nationwide database analysis

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