Rapid response systems: are they really effective?

Sandroni, Claudio; D’Arrigo, Sonia; Antonelli, Massimo

doi:10.1186/s13054-015-0807-y

Cited by 38 publications

(22 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Wczesna identyfikacja stanu zagrożenia życia, czemu służy między innymi system wczesnego ostrzegania (EWS, early warning system), pozwala według niektórych źródeł na zmniejszenie częstości występowania wewnątrzszpitalnego NZK [17]. Możliwie wczesna ocena stanu klinicznego pacjenta pod kątem rokowania pozwala jednak na uniknięcie resuscytacji daremnej [13].…”

Section: Dyskusjaunclassified

Ocena częstości występowania wewnątrzszpitalnego nagłego zatrzymania krążenia w Polsce

Adamski¹,

Nowakowski²,

Goryński³

et al. 2016

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Background: In-hospital cardiac arrest with its poor prognosis is a challenging problem in hospitals. The aim of this study was to evaluate in Polish hospitals the frequency of in-hospital cardiac arrests with the subsequent mortality, with special emphasis on the type of unit at which the event occurred, and the patient's demographic data, such as age and sex. Methods: The study was a retrospective analysis of data for 2012 registered in the Polish General Hospital Morbidity Study. This research covered all Polish hospitals, excluding only government and psychiatric hospitals. The study inclusion criterion was the incidence of cardiac arrest in any hospital ward, recorded by the respective ICD-10 diagnosis code. Results: Of the 7,775,553 patients hospitalized, the diagnosis of cardiac arrest was reported in a total of 22,602 patients, which included 22,317 adults (98.7% of all patients) and 285 children (1.3%). Overall mortality after cardiac arrest among adults was 74.2%, and in children 46.7%. In both absolute numbers and as percentages of all documented cases, cardiac arrests occurred most often at the departments of intensive care, internal medicine, cardiology and emergency medicine. The accompanying mortal ity was lower than average at the departments of intensive care, cardiology, cardiology high dependency unit and emergency medicine. The median age of patients with cardiac arrest who died in the hospital was higher than the median age of those who survived (72 vs. 64; P < 0.05). Although cardiac arrests were reported more often among men than women (58.2% vs. 41.8%; P < 0.001), the hospital mortality was higher among women (79.2% vs. 71.6%; P < 0.001). Conclusion:The frequency of in-hospital cardiac arrests in Polish hospitals and the subsequent mortality is not substantially different from that observed in other countries. However, our study, based on ICD-10 diagnosis codes, gives only limited information about the patients and circumstances of this event. An in-depth analysis of the causes, prognoses, and outcome of in-hospital cardiac arrests could be facilitated by the creation of a national registry.

show abstract

Section: Dyskusjaunclassified

Ocena częstości występowania wewnątrzszpitalnego nagłego zatrzymania krążenia w Polsce

Adamski¹,

Nowakowski²,

Goryński³

et al. 2016

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

show abstract

“…Thus far the evidence on MET/RRT adoption has mainly originated from outside continental Europe [13]. In a recent article in Intensive Care Medicine, Jung and colleagues retrospectively analysed patients' outcomes after RRT implementation in one hospital (RRT hospital) and compared these to outcomes from three other hospitals (non-RRT hospitals) in the south of France [14].…”

mentioning

confidence: 99%

Finally time for rapid response systems to be well MET in Europe?

Skrifvars

Martín‐Loeches²

2016

Intensive Care Med

View full text Add to dashboard Cite

Time is life. In medicine there are many "time-dependent" diseases: sepsis and cardiac arrest to name but two [1,2]. In order to improve patient outcome, it is imperative to define and characterize hospital workflows to facilitate good process of care. Several factors need to be synchronized, including coordination between different departments in the hospital [3]. Early communication and a multidisciplinary approach can dramatically change the management of patients. The goal of modern intensive care medicine is to optimize and maximize quality of patient care. It is desirable to foster an overview of the process of critical care and base it on clinical need of patients and less on hospital location. Clinical management and monitoring of severely ill patients before admission to intensive care units (ICU) have frequently been shown to be suboptimal [4,5]. Delays in patient admission to ICU are associated with a longer hospital stay and worse outcome. Recently, Harris et al. prospectively analysed the outcome of a large UK population from 48 hospitals and concluded that the deteriorating ward patient has a high short-term mortality; however, with early ICU admission an impressive 50 % reduction of 90-day mortality is possible [6].Clinical conditions at risk are usually preceded by pathophysiological alterations that are both detectable and preventable. As early as the late 1990s, patient-atrisk teams, medical emergency teams (METs) or rapid response teams (RRT) were created to early detect patients at risk on general wards [7]. In the USA, the Institute for Healthcare Improvement (IHI) recommended, more than 10 years ago, that hospitals should implement RRTs and/or METs for the identification of non-ICU patients at risk of deterioration [8,9].Meta-analyses, including 30 before-after studies, cohort studies and cluster randomized trials found that implementation of an RRT/MET is associated with a reduction in non-ICU cardiopulmonary arrests but the effect on hospital mortality is less clear [10,11]. In the UK, early warning scores (EWS) based on "track and trigger" systems have for several years been used to flag and alert patients at risk and develop a rapid response by in-hospital teams with critical care skills to stabilize patients and expedite admission to ICU [12].Thus far the evidence on MET/RRT adoption has mainly originated from outside continental Europe [13]. In a recent article in Intensive Care Medicine, Jung and colleagues retrospectively analysed patients' outcomes after RRT implementation in one hospital (RRT hospital) and compared these to outcomes from three other hospitals (non-RRT hospitals) in the south of France [14]. In essence, the authors replicated a system that was developed 25 years ago and recommended by current resuscitation guidelines [15]. The study showed an impressive decrease in hospital mortality in the hospital with RRT implementation. There are not many interventions in ICU that can be attributed to a similar decrease in mortality and the authors should be congratulated for s...

show abstract

“…The MERIT trial [48] had a strong level of evidence, but it showed no improvement in outcomes. Moreover, controversies remain on the results of the studies and on the relationship between RRSs and clinical outcomes [75].…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, a populationbased study [65] reported the rate of IHCA (number of IHCAs divided by the total number of admissions) and IHCA-related mortality (number of deaths among those patients who suffered an IHCA divided by the total number of admissions). Hospital mortality represents the most important outcome measure for RRSs [75], but its reduction depends from what we want to measure. The total hospital mortality considers unexpected plus expected death, that is death after a NFR order.…”

Section: Is There a Role For Evidence-based Medicine In The Rrs Evalumentioning

confidence: 99%

Rapid Response Systems: how to interpret levels of evidence

Difonzo

2017

CMI

View full text Add to dashboard Cite

Clinical management abstractBACKGROUND AND AIM: The Rapid Response System (RRS) has been introduced to prevent cardiac arrest, unplanned admissions to the intensive care unit, and death in hospitalized patients. Despite the constant and widespread presence of this system in worldwide hospitals, it remains debated whether its use improves patient outcomes. The aim of this narrative review is to describe the available evidence supporting the effectiveness of RRSs and to discuss the controversies on the lack of level 1 evidence studies. METHODS: The literature search covers the period from 1 January 2000 to 31 March 2016. RESULTS: Studies with different research designs, observational, quasi-experimental with non-randomized control group and experimental, and aggregate data of meta-analyses indicate a statistically significant reduction of in-hospital cardiac arrests and hospital mortality associated with the deployment of RRSs. CONCLUSIONS: A RRS is a complex intervention in a complex system, such as a hospital. This complexity does not allow considering experimental trials only as the most appropriate methodology to answer at research objectives. Furthermore, the benefits of a RRS depend greatly on its proper use. Accumulating evidence suggests the importance to investigate barriers and facilitators that can affect the integration, within a hospital, of this complex intervention.

show abstract

Rapid response systems: are they really effective?

Cited by 38 publications

References 41 publications

Ocena częstości występowania wewnątrzszpitalnego nagłego zatrzymania krążenia w Polsce

Ocena częstości występowania wewnątrzszpitalnego nagłego zatrzymania krążenia w Polsce

Finally time for rapid response systems to be well MET in Europe?

Rapid Response Systems: how to interpret levels of evidence

Contact Info

Product

Resources

About