Acute Crit Care.  2019 Nov;34(4):246-254. 10.4266/acc.2019.00668.

Effect of a rapid response system on code rates and in-hospital mortality in medical wards

• Lee HY
• Lee J
• Lee SM
• Kim S
• Yang E
• Lee HJ
• Lee H
• Ryu HG
• Oh SY
• Ha EJ
• Ko SB
• Cho J

• KMID: 2467303
• DOI: http://doi.org/10.4266/acc.2019.00668

Abstract

BACKGROUND
To determine the effects of implementing a rapid response system (RRS) on code rates and in-hospital mortality in medical wards.
METHODS
This retrospective study included adult patients admitted to medical wards at Seoul National University Hospital between July 12, 2016 and March 12, 2018; the sample comprised 4,224 patients admitted 10 months before RRS implementation and 4,168 patients admitted 10 months following RRS implementation. Our RRS only worked during the daytime (7 AM to 7 PM) on weekdays. We compared code rates and in-hospital mortality rates between the preintervention and postintervention groups.
RESULTS
There were 62.3 RRS activations per 1,000 admissions. The most common reasons for RRS activation were tachypnea or hypopnea (44%), hypoxia (31%), and tachycardia or bradycardia (21%). Code rates from medical wards during RRS operating times significantly decreased from 3.55 to 0.96 per 1,000 admissions (adjusted odds ratio [aOR], 0.29; 95% confidence interval [CI], 0.10 to 0.87; P=0.028) after RRS implementation. However, code rates from medical wards during RRS nonoperating times did not differ between the preintervention and postintervention groups (2.60 vs. 3.12 per 1,000 admissions; aOR, 1.23; 95% CI, 0.55 to 2.76; P=0.614). In-hospital mortality significantly decreased from 56.3 to 42.7 per 1,000 admissions after RRS implementation (aOR, 0.79; 95% CI, 0.64 to 0.97; P=0.024).
CONCLUSIONS
Implementation of an RRS was associated with significant reductions in code rates during RRS operating times and in-hospital mortality in medical wards.

Keyword

cardiopulmonary resuscitation; hospital mortality; hospital rapid response team; internal medicine

MeSH Terms

Adult
Anoxia
Bradycardia
Cardiopulmonary Resuscitation
Hospital Mortality*
Hospital Rapid Response Team
Humans
Internal Medicine
Odds Ratio
Retrospective Studies
Seoul
Tachycardia
Tachypnea

Figure

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  Figure 1. Monthly trends in code rates per 1,000 admissions.

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  Figure 2. Monthly trends in in-hospital mortality per 1,000 admissions.

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