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

Abstract

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.

Prevalence of rapid response systems in small hospitals

“…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 ]…”

“…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][17][18] The code calls were widely available in acute-care hospitals, although small acute-care hospitals (23%) had no systematic protocols for hospital emergencies. From our search for articles, the prevalence of the code calls in the world worldwide was unknown; thus, we could not compare the rate to others.…”

“…However, in smaller hospitals, the prevalence of MET or RRS activation before obvious patient deterioration was remarkably low. 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] …”

“…Despite its importance, the prevalence of the RRS in Japan is not well known, although it is possibly influenced by the hospital care type and staff capacity [14,15] . Recently, Naito et al [16] published a descriptive summary from 35 institutes that registered activity data of their RRT/MET to an In-Hospital Emergency Committee in Japan (IHEC-J) [17,18] . This depicts the status of large acute-care hospitals.…”

“…[14,15] Recently, Naito et al [16] published a descriptive summary from 35 institutes that registered activity data of their RRT/MET to an In-Hospital Emergency Committee in Japan (IHEC-J). [17,18] This depicts the status of large acute-care hospitals. An evaluation that includes smaller hospitals is necessary, given that a considerable number of smaller hospitals are involved in acute-care provision in Japan.…”