Effect of implementation of rapid response system in a children's hospital

DOI 1 Citations 15 References
  • Kawasaki Tatsuya
    Department of Pediatric Critical Care, Shizuoka Children's Hospital
  • Sekine Yuji
    Department of Emergency and General Pediatrics, Shizuoka Children's Hospital
  • Shiozaki Manako
    Department of Nursing, Shizuoka Children's Hospital
  • Kamata Mineto
    Department of Anesthesiology, Shizuoka Children's Hospital
  • Kitamura Yuji
    Department of Anesthesiology, Shizuoka Children's Hospital
  • Kawane Kiyomi
    Department of Nursing, Shizuoka Children's Hospital
  • Kato Hiroyuki
    Department of Emergency and General Pediatrics, Shizuoka Children's Hospital

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Other Title
  • 小児専門病院におけるrapid response system導入の効果
  • Effect of implementation of rapid response system in a children^|^apos;s hospital

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Abstract

Objective The rapid response system (RRS) has been implicated in decreasing the incidence of unexpected cardiac arrest in wards and hospital mortality. It has recently been incorporated in medical safety campaigns in many countries. Our hospital implemented RRS aiming to reduce the incidence of cardiac arrest in wards. Methods: RRS, which was commenced in September 2009, could be activated by all doctors, nurses, and rehabilitation staff in the hospital. All cases were prospectively recorded. We conducted a before-and-after study to compare the incidences of unexpected cardiac arrest in wards and hospital mortality 24 months after RRS implementation. Results: There were 68 cases of RRS activation during the 24 months of the study (6.6 cases per 1,000 hospital admissions). The incidence of unexpected cardiac arrest in wards (from 0.70 to 0.68 per 1,000 admissions) and that of hospital mortality (from 8.56 to 7.62 per 1,000 admissions) remained approximately the same despite RRS implementation. However, ICU mortality rate in patients who were unexpectedly admitted to the ICU was significantly reduced [from 10.7% to 3.8%; relative risk 0.36, 95% confidence interval (CI) 0.13–0.98]. Conclusion: Although RRS implementation in our hospital did not contribute to a reduction in the incidence of unexpected cardiac arrest in wards and hospital mortality, the mortality rate in unplanned ICU admissions from ward was significantly reduced. The search for a better system and a regular audit is further required.

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