1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
2Rapid Response Team, Seoul National University Hospital, Seoul, Korea
3Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
4Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
5Department of General Surgery, Seoul National University Hospital, Seoul, Korea
6Critical Care Center, Seoul National University Hospital, Seoul, Korea
7Department of Neurology, Seoul National University Hospital, Seoul, Korea
Copyright © 2019 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conceptualization: JC. Data curation: EY, SK. Formal analysis: HYL. Methodology: HJL, HL, SYO, EJH. Project administration: SML, SBK, HGR. Visualization: HYL. Writing - original draft: HYL. Writing - review & editing: JC, SML, JL.
Variable | Preintervention (n=4,224) | Postintervention (n=4,168) | P-value |
---|---|---|---|
Age (yr) | 61.7±15.4 | 61.3±15.2 | 0.330 |
Sex | 0.525 | ||
Female | 1,778 (42.1) | 1,784 (42.8) | |
Male | 2,446 (57.9) | 2,384 (57.2) | |
Admitting specialty | <0.001 | ||
Respiratory | 1,345 (31.8) | 1,396 (33.5) | |
Hemato-oncology | 1,389 (32.9) | 1,220 (29.3) | |
Gastroenterology | 709 (16.8) | 934 (22.4) | |
Cardiology | 482 (11.4) | 369 (8.9) | |
Nephrology | 79 (1.9) | 73 (1.8) | |
Othersa | 220 (5.2) | 176 (4.2) | |
Vital sign | |||
Respiratory rate (/min) | 20 (20–20) | 20 (20–20) | 0.545 |
Body temperature (°C) | 36.6 (36.3–36.9) | 36.5 (36.3–36.8) | 0.044 |
Systolic blood pressure (mm Hg) | 123 (111–136) | 124 (112–136) | 0.065 |
Diastolic blood pressure (mm Hg) | 75 (68–83) | 75 (68–83) | 0.180 |
Heart rate (/min) | 83 (73–96) | 82 (71–94) | <0.001 |
MEWS | 1.6±1.1 | 1.5±1.0 | <0.001 |
MEWS critical score | 0.294 | ||
<5 | 4,121 (97.6) | 4,058 (97.9) | |
≥5 | 102 (2.4) | 85 (2.1) |
Variable | RRS activation (N=260) |
---|---|
Call of care from the RRS per 1,000 admissions | 62.3 |
Male sex | 156 (60.0) |
Age (yr) | 60.7±15.2 |
Modified Early Warning Score | 4.7±2.1 |
Medical specialty for admitted patients | |
Hemato-oncology | 132 (50.8) |
Respiratory | 105 (40.4) |
Gastroenterology | 20 (7.7) |
Cardiology | 2 (0.8) |
Nephrology | 1 (0.4) |
Endocrinology | 1 (0.4) |
Route of RRS activation | |
RRS member | 231 (88.8) |
Nurse | 22 (8.5) |
Physician | 7 (2.7) |
Reason cited for activating RRSa | |
Respiratory reason | 194 (74.6) |
Respiratory rate ≤8 or ≥28/min, sudden stridor, or use of accessory muscles | 114 (43.8) |
Oxygen saturation <90% | 80 (30.8) |
Circulatory reason | 106 (40.8) |
Heart rate ≤40 or ≥130/min, symptomatic arrhythmia | 54 (20.8) |
Systolic blood pressure ≤80 or ≥200 mm Hg | 52 (20.0) |
Staff worried: concern about overall deterioration | 23 (8.8) |
Altered neurological status, seizure | 7 (2.7) |
Body temperature >39°C or <36°C | 7 (2.7) |
Laboratory reason | 10 (3.9) |
Abnormal arterial blood gas test: pH <7.25, PaCO2 >50 mm Hg, or PaO2 <55 mm Hg | 5 (1.9) |
Metabolic acidosis: lactic acid >4 mEq/L, total CO2 <15 mmol/L | 3 (1.2) |
Electrolyte imbalance (potassium, magnesium, phosphate, calcium) | 2 (0.8) |
Outcomea | |
Consultation by RRS physician | 93 (35.7) |
Transfer to ICU | 56 (21.5) |
Intervention by RRS physician | 53 (20.4) |
Intervention by RRS nurse | 45 (17.3) |
Accompanying patient to radiology | 12 (4.6) |
Transfer to operating room | 1 (0.4) |
Outcome | Estimate (SE) | Adjusted ORa (95% CI) | P-value |
---|---|---|---|
Total codes from medical wards | –0.36 (0.31) | 0.70 (0.38–1.27) | 0.242 |
Code from medical wards during RRS operating times | –1.24 (0.57) | 0.29 (0.10–0.87) | 0.028 |
Code from medical wards during RRS nonoperating times | 0.21 (0.41) | 1.23 (0.55–2.76) | 0.614 |
Code for the first 24 hours of unplanned ICU admission from medical wards | –0.97 (0.48) | 0.39 (0.15–0.99) | 0.047 |
In-hospital mortality rate per 1,000 admissions | –0.24 (0.10) | 0.79 (0.64–0.97) | 0.024 |
Our RRS worked during daytime hours (7 AM to 7 PM) on weekdays.
RRS: rapid response system; SE: standard error; OR: odds ratio; CI: confidence interval; ICU: intensive care unit; MEWS: Modified Early Warning Score.
a Adjusted for age, sex, admitting specialty, and critical score of MEWS at admission.