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Tytuł:
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Impact of increased calls to rapid response systems on unplanned ICU admission.
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Autorzy:
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Kurita T; Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan.
Nakada TA; Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan. Electronic address: .
Kawaguchi R; Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan.
Fujitani S; Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa 216-8511, Japan.
Atagi K; Intensive Care Unit, Nara General Medical Center, 2-897-5, Shichijonishi, Nara-shi, Nara 630-8581, Japan. Electronic address: .
Naito T; Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa 216-8511, Japan.
Arai M; Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara-shi, Kanagawa 252-0373, Japan.
Arimoto H; Department of Emergency and Critical Care Medical Center Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan. Electronic address: .
Masuyama T; Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama 330-8503, Japan.
Oda S; Chiba University Graduate School of Medicine, Department of Emergency and Critical Care Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan. Electronic address: .
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Corporate Authors:
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IHER-J collaborators
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Źródło:
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The American journal of emergency medicine [Am J Emerg Med] 2020 Jul; Vol. 38 (7), pp. 1327-1331. Date of Electronic Publication: 2019 Nov 18.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 1983- : Philadelphia, PA : W B Saunders
Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
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MeSH Terms:
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Critical Care Outcomes*
Hospital Mortality*
Hospital Bed Capacity/*statistics & numerical data
Hospital Rapid Response Team/*statistics & numerical data
Intensive Care Units/*statistics & numerical data
Aged ; Aged, 80 and over ; Critical Care ; Female ; Heart Arrest/therapy ; Hospitalization/statistics & numerical data ; Humans ; Japan ; Male ; Middle Aged ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Wounds and Injuries/therapy
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Contributed Indexing:
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Keywords: Call rate; Critical care; Hospital size; Rapid response system; Unexpected adverse event; Unplanned ICU admission
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Entry Date(s):
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Date Created: 20191218 Date Completed: 20200824 Latest Revision: 20200824
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Update Code:
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20240105
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DOI:
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10.1016/j.ajem.2019.10.028
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PMID:
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31843333
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Background: Whether hospital bed number and rapid response system (RRS) call rate is associated with the clinical outcomes of patients who have RRS activations is unknown. We test a hypothesis that hospital volume and RRS call rates are associated with the clinical outcomes of patients with RRSs.
Methods: This is a retrospective chart analysis of an existing dataset associated with In-Hospital Emergency Registry in Japan. In the present study, 4818 patients in 24 hospitals from April 2014 to March 2018 were analyzed. Primary outcome variable was an unplanned intensive care unit (ICU) admission after RRS activation.
Results: In the primary analysis of the study using a multivariate analysis adjusting potential confounding factors, higher RRS call rate was significantly associated with decreased unplanned ICU admissions (P < 0.0001, Odds ratio [OR] 0.95, 95% confidence interval [CI] 0.92-0.98), but there was no significant association of hospital volume with unplanned ICU admissions (P = 0.44). In the secondary analysis of the study, there was a non-significant trend of increased cardiac arrest on arrival at the location of the RRS provider at large-volume hospitals (P = 0.084, OR 1.16, 95% CI 0.98-1.38). Large-volume hospitals had a significantly higher 1-month mortality rate (P = 0.0040, OR 1.10, 95% CI 1.03-1.18).
Conclusion: Hospitals with increased RRS call rates had significantly decreased unplanned ICU admission in patients who had RRS activations. Patients who had RRS activations at large-volume hospitals had an increased 1-month mortality rate.
Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
