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

Tatsuya Kawasaki, Yuji Sekine, Manako Shiozaki, Mineto Kamata, Yuji Kitamura, Kiyomi Kawane, Hiroyuki Kato
2013 Journal of the Japanese Society of Intensive Care Medicine  
要約: 【背景】 Rapid response system (RRS) は予期せぬ病棟心停止や死亡率を減らす可能性が 示唆され,国内外の医療安全指針に採用されている。 【方法】 2009 年 9 月より当院にて全医師・ 看護師・リハビリスタッフが起動可能な RRS を導入した。全事案を前向き記録し,導入後 24ヶ月間の病棟心停止の発生率や院内死亡率を導入前 27ヶ月間と前後比較した。 【結果】 RRS 起動件数は 68 件 (1,000 入院当たり 6.6 件) 。RRS 導入前後で病棟心停止 (同前 0.70,後 0.68) や 院内死亡率 (同前 8.56,後 7.62) は低下しなかったが,病棟からの ICU 予定外入室患者の死亡 率 〔前 10.7%,後 3.8%;RR (relative risk) 0.36,95% CI (confidence interval) 0.13 -0.98〕 は 有意に低下した。 【結論】 RRS 導入前後の約 2 年間ずつの観察では病棟心停止や院内死亡率の 改善は認めなかった。今後もシステムを改善し評価を継続する方針である。
more » ... ve: 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.
doi:10.3918/jsicm.20.601 fatcat:cg62spcmbbgwdj6t6ezm6u2nhm