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Effectiveness of a daytime rapid response system in hospitalized surgical ward patients

机译：住院病病房患者白天快速响应系统的有效性

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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; P0.001).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.
机译：背景：住院期间的临床劣化通常可以预防快速响应系统（RRS）。我们旨在调查白天RRS对外科住院患者的有效性。方法：从2013年8月至2017年7月（2013年8月至2015年7月，2017年7月，在2017年8月（2013年7月至2015年7月，2015年7月，在20名普通外科病房中进行了回顾性队列研究rrs-ovie; 2015年8月至2017年7月，后rrs-期间）。当RRS运营时，主要结果是心肺逮捕（CPA）的发病率。二次结果是总体和可预防的心肺动脉抑制的发生率，即医院死亡率，“不要重新播出”命令的百分比，以及出院的CPA患者的生存。结果：每1000个招生CPA的相对风险（RR） RRS在rrs-ech周期中运行时间（每日从早上7点到7点）的时间为0.53（置信区间95％]，0.25至1.13; P = 0.099）和RR无论RRS运行时间为0.76（95％CI，0.46至1.28; P = 0.301）。 RRS实施后可预防的CPA显着低于RRS实施前（RR，0.31; 95％CI，0.11至0.88; P = 0.028）。住院内死亡率没有统计学差异和医院内心骤停的患者的存活率。与RRS期间（RR，1.91; 95％CI，1.40至2.59; P <0.001）相比，在RRS实施期间，在RRS实施期间，恢复决策在RRS实施期间明显增加降低CPA的速率，而系统在系统运行期间有效降低了期间可预防的CPA速率。

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