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Original Article
Rapid response system
Effectiveness of a daytime rapid response system in hospitalized surgical ward patients
Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh
Acute Crit Care. 2020;35(2):77-86.   Published online May 13, 2020
DOI: https://doi.org/10.4266/acc.2019.00661
  • 6,468 View
  • 213 Download
  • 6 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
Background
Clinical deteriorations during hospitalization are often preventable with a rapid response system (RRS). We aimed to investigate the effectiveness of a daytime RRS for surgical hospitalized patients.
Methods
A retrospective cohort study was conducted in 20 general surgical wards at a 1,779-bed University hospital from August 2013 to July 2017 (August 2013 to July 2015, pre-RRS-period; August 2015 to July 2017, post-RRS-period). The primary outcome was incidence of cardiopulmonary arrest (CPA) when the RRS was operating. The secondary outcomes were the incidence of total and preventable cardiopulmonary arrest, in-hospital mortality, the percentage of “do not resuscitate” orders, and the survival of discharged CPA patients.
Results
The relative risk (RR) of CPA per 1,000 admissions during RRS operational hours (weekdays from 7 AM to 7 PM) in the post-RRS-period compared to the pre-RRS-period was 0.53 (95% confidence interval [CI], 0.25 to 1.13; P=0.099) and the RR of total CPA regardless of RRS operating hours was 0.76 (95% CI, 0.46 to 1.28; P=0.301). The preventable CPA after RRS implementation was significantly lower than that before RRS implementation (RR, 0.31; 95% CI, 0.11 to 0.88; P=0.028). There were no statistical differences in in-hospital mortality and the survival rate of patients with in-hospital cardiac arrest. Do-not-resuscitate decisions significantly increased during after RRS implementation periods compared to pre-RRS periods (RR, 1.91; 95% CI, 1.40 to 2.59; P<0.001).
Conclusions
The day-time implementation of the RRS did not significantly reduce the rate of CPA whereas the system effectively reduced the rate of preventable CPA during periods when the system was operating.

Citations

Citations to this article as recorded by  
  • Development and Validation of a Machine Learning Algorithm Using Clinical Pages to Predict Imminent Clinical Deterioration
    Bryan D. Steitz, Allison B. McCoy, Thomas J. Reese, Siru Liu, Liza Weavind, Kipp Shipley, Elise Russo, Adam Wright
    Journal of General Internal Medicine.2024; 39(1): 27.     CrossRef
  • Effects of a Rapid Response Team on Patient Outcomes: A Systematic Review
    Qiuxia Zhang, Khuan Lee, Zawiah Mansor, Iskasymar Ismail, Yi Guo, Qiao Xiao, Poh Ying Lim
    Heart & Lung.2024; 63: 51.     CrossRef
  • Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
    Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
    Annals of Surgical Treatment and Research.2023; 104(1): 43.     CrossRef
  • The associations between rapid response systems and their components with patient outcomes: A scoping review
    Rebecca J. Piasecki, Cheryl R. Dennison Himmelfarb, Kelly T. Gleason, Rachel M. Justice, Elizabeth A. Hunt
    International Journal of Nursing Studies Advances.2023; 5: 100134.     CrossRef
  • Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act
    Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
    Acute and Critical Care.2022; 37(2): 237.     CrossRef
  • Estructura y función de los equipos de respuesta rápida para la atención de adultos en contextos hospitalarios de alta complejidad: Revisión sistemática de alcance
    Juliana Vanessa Rincón-López, Diego Larrotta-Castillo, Kelly Estrada-Orozco, Hernando Gaitán-Duarte
    Revista Colombiana de Obstetricia y Ginecología.2021; 72(2): 171.     CrossRef
  • Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
    Sang Hyuk Kim, Ji Young Hong, Youlim Kim
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
    Mi-Jung Yoon, Jin-Hee Park
    Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491.     CrossRef
Review Article
Rapid response system
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute Crit Care. 2019;34(2):108-116.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00535
  • 12,079 View
  • 398 Download
  • 21 Web of Science
  • 22 Crossref
AbstractAbstract PDF
The inpatient treatment process is becoming more and more complicated with advanced treatments, aging of the patient population, and multiple comorbidities. During the process, patients often experience unexpected deterioration, about half of which might be preventable. Early identification of patient deterioration and the proper response are priorities in most healthcare facilities. A rapid response system (RRS) is a safety net to identify antecedents of these adverse events and to respond in a timely manner. The RRS has become an essential part of the medical system worldwide, supported by all major quality improvement organizations. An RRS consists of a trigger system and response team and needs constant assessment and process improvement. Although the effectiveness and cost-benefit of RRS remain controversial, according to previous studies, it may be beneficial by decreasing in-hospital cardiac arrest and mortality. Since the first implementation of RRS in Korea in 2008, it has been developed in over 15 medical centers and continues to expand. Recent accreditation standards and an RRS pilot program by the Korean government will promote the proliferation of RRSs in Korea.

Citations

Citations to this article as recorded by  
  • Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study
    Yoon Hae Ahn, Jinwoo Lee, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Haein Lee, Chae-Man Lim, Sang-Min Lee, Hong Yeul Lee, Chae-Man Lim, Sang-Bum Hong, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Su
    Journal of Intensive Care.2023;[Epub]     CrossRef
  • Findings from a decade of experience following implementation of a Rapid Response System into an Asian hospital
    Augustine Tee, Bryan Peide Choo, Roshni Sadashiv Gokhale, Xiqin Wang, Mashithah Mansor, Hong Choon Oh, Daryl Jones
    Resuscitation Plus.2023; 16: 100461.     CrossRef
  • Development of a comprehensive model for the role of the rapid response team nurse
    Youn-Hui Won, Jiyeon Kang
    Intensive and Critical Care Nursing.2022; 68: 103136.     CrossRef
  • Characteristics and outcomes of patients screened by rapid response team who transferred to the intensive care unit
    Song-I. Lee, Jeong Suk Koh, Yoon Joo Kim, Da Hyun Kang, Jeong Eun Lee
    BMC Emergency Medicine.2022;[Epub]     CrossRef
  • Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study
    Dong-gon Hyun, Su Yeon Lee, Jee Hwan Ahn, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Sunghoon Park, Jeongwon Heo, Jae-myeong Lee, Kyung Cha
    Critical Care.2022;[Epub]     CrossRef
  • Korean nurses’ perception and performance on communication with physicians in clinical deterioration
    Bo-Gyeong Jin, Kyoungrim Kang, Hyun-Jin Cho
    Medicine.2022; 101(38): e30570.     CrossRef
  • Clinical Nurses’ Intention to Use Defibrillators in South Korea: A Path Analysis
    Dongchoon Uhm, Gye-Hyun Jung
    Healthcare.2022; 11(1): 61.     CrossRef
  • Rapid Response System Should Be Enhanced at Non-general Ward Locations: a Retrospective Multicenter Cohort Study in Korea
    Byung Ju Kang, Sang-Bum Hong, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Jae Young Moon, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jong-Joon Ahn
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study
    Jinmi Lee, Yujung Shin, Eunjoo Choi, Sunhui Choi, Jeongsuk Son, Youn Kyung Jung, Sang-Bum Hong, Tai-Heng Chen
    PLOS ONE.2021; 16(2): e0247066.     CrossRef
  • A multicentre validation study of the deep learning-based early warning score for predicting in-hospital cardiac arrest in patients admitted to general wards
    Yeon Joo Lee, Kyung-Jae Cho, Oyeon Kwon, Hyunho Park, Yeha Lee, Joon-Myoung Kwon, Jinsik Park, Jung Soo Kim, Man-Jong Lee, Ah Jin Kim, Ryoung-Eun Ko, Kyeongman Jeon, You Hwan Jo
    Resuscitation.2021; 163: 78.     CrossRef
  • Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
    Sang Hyuk Kim, Ji Young Hong, Youlim Kim
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study
    Sang Hyuk Kim, Hye Suk Choi, Eun Suk Jin, Hayoung Choi, Hyun Lee, Sang-Hwa Lee, Chang Youl Lee, Myung Goo Lee, Youlim Kim
    Scientific Reports.2021;[Epub]     CrossRef
  • A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea
    Su Yeon Lee, Jee Hwan Ahn, Byung Ju Kang, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jae Young Moon, Sang-Bum Hong, Amit Bahl
    PLOS ONE.2021; 16(10): e0258221.     CrossRef
  • Incorporating a real-time automatic alerting system based on electronic medical records could improve rapid response systems: a retrospective cohort study
    Seung-Hun You, Sun-Young Jung, Hyun Joo Lee, Sulhee Kim, Eunjin Yang
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2021;[Epub]     CrossRef
  • Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
    Mi-Jung Yoon, Jin-Hee Park
    Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491.     CrossRef
  • Early Warning Score and Cancer Patients at End-of-Life
    Jae-woo Lee, Ye-Seul Kim, Yonghwan Kim, Hyo-Sun Yoo, Hee-Taik Kang
    Korean Journal of Clinical Geriatrics.2021; 22(2): 67.     CrossRef
  • Effectiveness of a daytime rapid response system in hospitalized surgical ward patients
    Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh
    Acute and Critical Care.2020; 35(2): 77.     CrossRef
  • Current State and Strategy for Establishing a Digitally Innovative Hospital: Memorial Review Article for Opening of Yongin Severance Hospital
    Soo-Jeong Kim, Ji Woong Roh, Sungwon Kim, Jin Young Park, Donghoon Choi
    Yonsei Medical Journal.2020; 61(8): 647.     CrossRef
  • Bleeding management after implementation of the Hemorrhage Code (Code H) at the Hospital Israelita Albert Einstein, São Paulo, Brazil
    Michele Jaures, Neila Maria Marques Negrini Pigatti, Roseny dos Reis Rodrigues, Fernanda Paulino Fernandes, João Carlos de Campos Guerra
    Einstein (São Paulo).2020;[Epub]     CrossRef
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    Youngjoon Kang
    Acute and Critical Care.2019; 34(3): 173.     CrossRef
  • Effect of a rapid response system on code rates and in-hospital mortality in medical wards
    Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Sulhee Kim, Eunjin Yang, Hyun Joo Lee, Hannah Lee, Ho Geol Ryu, Seung-Young Oh, Eun Jin Ha, Sang-Bae Ko, Jaeyoung Cho
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    Jae Hwa Cho
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Original Article
Rapid response system
Rapid Response Systems Reduce In-Hospital Cardiopulmonary Arrest: A Pilot Study and Motivation for a Nationwide Survey
Yeonhee Park, Jong-Joon Ahn, Byung Ju Kang, Young Seok Lee, Sang-Ook Ha, Jin-Soo Min, Woo-Hyun Cho, Se-Hee Na, Dong-Hyun Lee, Seung-Yong Park, Goo-Hyeon Hong, Hyun-Jung Kim, Sangwoo Shim, Jung-Hyun Kim, Seok-Jeong Lee, So-Young Park, Jae Young Moon
Korean J Crit Care Med. 2017;32(3):231-239.   Published online August 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00024
  • 8,119 View
  • 230 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Background
Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest. The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs) and the current level of cardiopulmonary arrest rate in tertiary hospitals. Methods: This was a retrospective study based on data from 14 tertiary hospitals. Cardiopulmonary resuscitation (CPR) rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present. Results: Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009). Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854). National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001). High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001) and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001). Conclusions: RRSs may be a feasible option to reduce the CPR rate. The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics.

Citations

Citations to this article as recorded by  
  • Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
    Kimia Honarmand, Randy S. Wax, Daleen Penoyer, Geoffery Lighthall, Valerie Danesh, Bram Rochwerg, Michael L. Cheatham, Daniel P. Davis, Michael DeVita, James Downar, Dana Edelson, Alison Fox-Robichaud, Shigeki Fujitani, Raeann M. Fuller, Helen Haskell, Ma
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ACC : Acute and Critical Care