Effect of the Ramathibodi Rapid Response System Triggered by the Ramathibodi Early Warning Score and Clinical Warning Signs on in-Hospital Mortality and the Incidence of Cardiopulmonary Resuscitation in Adult Hospitalized Patients

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics Therapeutics and Clinical Risk Management Pub Date : 2023-12-05 DOI:10.2147/tcrm.s426061

Chutipong Kwantong, Yuda Sutherasan, Detajin Junhasavasdikul, Tananchai Petnak, Pongdhep Theerawit

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Abstract

Purpose: The Ramathibodi Rapid Response System (RRRS), implemented in March 2017, aims to identify and respond to patients with deteriorating conditions outside the ICU. It employs the Ramathibodi early warning score and clinical signs to monitor all admitted patients, providing expert physician monitoring and early treatment for stabilization and appropriate care triage. This study assesses the RRRS’s effectiveness in reducing in-hospital mortality and CPR events outside the ICU.
Patients and Methods: We conducted a retrospective observational study from March 2014 to February 2020 in a tertiary care hospital’s general wards. We included adult patients experiencing unplanned ICU admission, sudden cardiac arrest, or unexpected death. The study compared in-hospital mortality and CPR incidence outside the ICU between pre- and post-RRRS implementation groups. The associations between RRRS implementation and in-hospital mortality and the incidence of CPR outside the ICU were assessed using multiple logistic regression analyses.
Results: We evaluated 17,741 admissions, with 9168 before RRRS implementation (1 March 2014 to 28 February 2017) and 8573 after RRRS implementation (1 March 2017 to 29 February 2020). The implementation of RRRS was associated with a significant reduction in in-hospital mortality, which decreased from 30.0% to 20.8% (odds ratio, 0.62; 95% confidence interval [CI], 0.57 to 0.66; P< 0.0001). Even after adjusting for age, sex, and comorbidities, the reduction in in-hospital mortality remained significant (adjusted odds ratio, 0.58; 95% CI, 0.54 to 0.63; P< 0.0001). The incidence of CPR outside the ICU also decreased from 1.8% to 1.1% (adjusted odds ratio, 0.6; 95% CI, 0.46 to 0.77; P< 0.0001). Additionally, the rate of ICU transfer increased from 85.4% to 92.1% (risk difference, 6.7; 95% CI, 7.6 to 5.8; P< 0.0001) after implementing the RRRS.
Conclusion: Implementing the RRRS is associated with a reduction in in-hospital mortality and the incidence of CPR outside the ICU.

Keywords: rapid response system, rapid response team, deteriorating patient, in-hospital mortality, cardiopulmonary resuscitation, intensive care unit, implementation protocol

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由Ramathibodi早期预警评分和临床预警信号触发的Ramathibodi快速反应系统对住院成人患者住院死亡率和心肺复苏发生率的影响

目的:Ramathibodi快速反应系统(RRRS)于2017年3月实施，旨在识别和应对ICU外病情恶化的患者。它采用Ramathibodi早期预警评分和临床症状来监测所有住院患者，提供专家医生监测和早期治疗，以实现稳定和适当的护理分诊。本研究评估RRRS在降低院内死亡率和ICU外心肺复苏术事件方面的有效性。患者和方法:我们于2014年3月至2020年2月在一家三级医院的普通病房进行了一项回顾性观察研究。我们纳入了意外入住ICU、心脏骤停或意外死亡的成年患者。该研究比较了实施rrrs前后两组的住院死亡率和ICU外心肺复苏术发生率。采用多元logistic回归分析评估RRRS实施与院内死亡率和ICU外心肺复苏术发生率之间的关系。结果:我们评估了17741名招生，其中9168名在RRRS实施前(2014年3月1日至2017年2月28日)，8573名在RRRS实施后(2017年3月1日至2020年2月29日)。RRRS的实施与住院死亡率的显著降低相关，从30.0%降至20.8%(优势比为0.62;95%置信区间[CI]， 0.57 ~ 0.66;术中;0.0001)。即使在对年龄、性别和合并症进行校正后，住院死亡率的降低仍然显著(校正优势比，0.58;95% CI, 0.54 ~ 0.63;术中;0.0001)。ICU外心肺复苏术的发生率也从1.8%降至1.1%(校正优势比为0.6;95% CI, 0.46 ~ 0.77;术中;0.0001)。ICU转院率由85.4%上升至92.1%(风险差6.7;95% CI, 7.6 - 5.8;术中;0.0001)。结论:实施RRRS可降低院内死亡率和ICU外心肺复苏术的发生率。关键词:快速反应系统，快速反应小组，病情恶化患者，院内死亡率，心肺复苏，重症监护病房，实施方案

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.