First report based on the online registry of a Japanese multicenter rapid response system: a descriptive study of 35 institutions in Japan

Naito, Takaki; Fujiwara, Shinsuke; Kawasaki, Tatsuya; Sento, Yoshiki; Nakada, Taka‐aki; Arai, Masayasu; Atagi, Kazuaki

doi:10.1002/ams2.454

Cited by 15 publications

(33 citation statements)

References 18 publications

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“…To understand the current status of RRS in this unique setting is crucial for the implementation of safer strategies to reduce postoperative SAEs in Japan. Thus, the present study, which is the first study focus on the postoperative RRS in Japan, aimed to investigate the characteristics, treatment and outcomes of Japanese postoperative patients who were managed by an RRS, based on multi-institutional data reported to the In-Hospital Emergency Registry in Japan (IHER-J) [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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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Section: Introductionmentioning

confidence: 99%

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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“…The inclusion of smaller hospitals is a new paradigm in the research on hospital emergency response systems, since the reports regarding RRS in hospitals were only selected institutes in the United State, [ 19 , 20 ] the United Kingdom, [ 21 ] Australia, [ 22 ] New Zealand, [ 23 ] and Japan. [ 16 – 18 ]…”

Section: Discussionmentioning

confidence: 99%

Prevalence of rapid response systems in small hospitals

et al. 2021

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The rapid response system (RRS) was introduced for early stage intervention in patients with deteriorating clinical conditions. Responses to unexpected in-hospital patient emergencies varied among hospitals. This study was conducted to understand the prevalence of RRS in smaller hospitals and to identify the need for improvements in the responses to in-hospital emergencies. A questionnaire survey of 971 acute-care hospitals in western Japan was conducted from May to June 2019 on types of in-hospital emergency response for patients in cardiac arrest (e.g., medical emergency teams [METs]), before obvious deterioration (e.g., rapid response teams [RRTs]), and areas for improvement. We received 149 responses, including those from 56 smaller hospitals (≤200 beds), which provided fewer responses than other hospitals. Response systems for cardiac arrest were used for at least a limited number of hours in 129 hospitals (87%). The absence of RRS was significantly more frequent in smaller hospitals than in larger hospitals (13/56, 23% vs 1/60, 2%; P < .01). METs and RRTs operated in 17 (11%) and 15 (10%) hospitals, respectively, and the operation rate for RRTs was significantly lower in smaller hospitals than in larger hospitals (1/56, 2% vs 12/60, 20%; P < .01). Respondents identified the need for education and more medical staff and supervisors; data collection or involvement of the medical safety management sector was ranked low. The prevalence of RRS or predetermined responses before obvious patient deterioration was ≤10% in small hospitals. Specific education and appointment of supervisors could support RRS in small hospitals.

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“…It is the mainstream practice in Japan to use the single parameter criteria, and in our hospital, the sin-gle parameter criteria has been used since the introduction of the RRS (Table 1). However, whether or not to actually request a MET based on this standard largely depends on the situational awareness of the nurses 9) ; it is thought that the number of requests is likely to be lower due to hesitation or reluctance to request an MET 10) . This seemed to frequently be the case in the early stages after the introduction of the RRS.…”

Section: Discussionmentioning

confidence: 99%

Rapid Response System in a University Hospital: A Five-Year Trend

Takamatsu

Yoshida

et al. 2020

J St. Marianna Univ

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Background: The rapid response system (RRS) aims to prevent unexpected cardiac arrest by responding to the deteriorating condition of hospitalized patients at an early stage. In this study, we evaluated the status of the RRS 5 years after its introduction in St. Marianna University School of Medicine Hospital. Methods: We retrospectively analyzed the medical emergency team (MET) request data of our hospital for the period of June 2010-May 2015. We compared the status of the RRS before and after the introduction of the critical care outreach team (CCOT) in August 2014. Results: There were 197 MET requests over the five-year period, with an increasing trend in the number of requests. Acute altered mental status was the most common reason for MET activation, followed by oxygen desaturation (measured by a pulse oximeter) < 90%, hypotension (blood pressure <90 mmHg), and cardiopulmonary arrest (CPA). The general ward requested the MET most frequently (62.9%). Overall, 47.7% of METactivated patients were transferred to intensive care unit, and 21.3 % were "non-transfer" cases. MET activation by general wards (55.6% vs. 78.1%, P=0.0017) and MET activation by CPA significantly increased (9.0% vs. 29.7%, P=0.0003) after the introduction of the CCOT, while the one-month survival/survival-to-hospital discharge rate significantly decreased (75.2% vs. 57.8%, P=0.0143). Discussion and Conclusion: Over the 5 years, the number of MET requests increased, especially after the introduction of the CCOT. When RRS was required due to cardiopulmonary arrest, the patient's condition had already deteriorated, and this was considered to have reduced the survival rate of RRS-activated patients. Comparing the data before and after the introduction of CCOT showed results different from the expected effect of RRS, probably because the RRS is usually triggered after a patient's condition clearly deteriorates. In the case of a cardiopulmonary arrest, when the patient's condition had already deteriorated and the number of CPA-related requests increased, a decrease in the survival rate was considered. Therefore, efforts must be made to request MET at an earlier stage and to use the Code Blue System to enable an earlier response for cases of cardiopulmonary arrest. Keywords Rapid response system, medical emergency team, critical care outreach team, cardiopulmonary arrest, 1-month survival/survival to discharge rate wards in the hospital, including the general ward; the attached emergency and critical care center included 10 beds in the ICU, six beds in the coronary care unit (CCU), four beds in the stroke care unit (SCU), and 32 beds in the high care unit (HCU).

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First report based on the online registry of a Japanese multicenter rapid response system: a descriptive study of 35 institutions in Japan

Cited by 15 publications

References 18 publications

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

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

Prevalence of rapid response systems in small hospitals

Rapid Response System in a University Hospital: A Five-Year Trend

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