Naohiro Hagawa1*, Etsuko Yamaguchi Nakagami2, Atsushi Shibata3, Shoichi Ehara3, Tetsuro Nishimura1 and Yasumitsu Mizobata1
1Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, Japan 2Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, Japan 3Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, JapanFulltext PDF
Aim: To evaluate effects of a modified Rapid Response System (RSS), management protocol, and education program in a Japanese university hospital where the conventional Medical Emergency Team (MET) interventions are not frequently activated. Methods: We conducted a retrospective single-center cohort study of all cases requiring MET calls in the 2 years periods before and after the implementation period in 2015. Results: MET calls were made for 52 patients per two years in the pre and 63 patients in the postimplementation period (1.34, 1.51 per 1000 admissions; RR 1.13, 95% CI 0.79 to 1.63, p=0.52), including 38 and 35 Unexpected Cardiac Arrest (UCA) cases (0.98, 0.84 per 1000 admissions; RR 0.86, 95% CI 0.54 to 1.36, p=0.56), and 14 and 28 non-cardiac arrests (0.36, 0.67 per 1000 hospital admissions; RR 1.87, 95% CI 0.98 to 3.55, p=0.06), respectively. The rate of MET calls for non CA increased by approximately twice. All unplanned ICU admissions significantly increased from 6.73 to 8.15 per 1000 admissions (RR 1.2, 95% CI 1.03 to 1.42, p=0.02). Twenty-eight-day mortality rates of MET call patients were 55% vs. 69% (pre vs. post; RR 1.57, 95% CI 1.132 to 3.198, p=0.025) for UCA and 29% vs. 29% for non-CA. Conclusion: Based on the increased MET calls for non-CA, the modified safety net we introduced appeared to help improve afferent limb failure. The hospitals where cultural and behavioral barriers associated with inter-professional hierarchies also remain should establish and evaluate modified safety nets according to each hospital’s actual situation.
Intensive care unit; Rapid response team; Medical emergency team; In-hospital cardiac arrest; Psychological safety
Hagawa N, Nakagami EY, Shibata A, Ehara S, Nishimura T, Mizobata Y. Effects of a Rapid Response System Adjusted for Hospitals Prone to Afferent Limb Failure: A Practical Way to Reduce Unexpected Adverse Events. Ann Med Medical Res. 2021; 4:1033..