key: cord-0725987-dfu0tlsg authors: Park, Yeonhee; Ahn, Jong-Joon; Kang, Byung Ju; Lee, Young Seok; Ha, Sang-Ook; Min, Jin-Soo; Cho, Woo-Hyun; Na, Se-Hee; Lee, Dong-Hyun; Park, Seung-Yong; Hong, Goo-Hyeon; Kim, Hyun-Jung; Shim, Sangwoo; Kim, Jung-Hyun; Lee, Seok-Jeong; Park, So-Young; Moon, Jae Young title: Rapid Response Systems Reduce In-Hospital Cardiopulmonary Arrest: A Pilot Study and Motivation for a Nationwide Survey date: 2017-08-31 journal: Korean J Crit Care Med DOI: 10.4266/kjccm.2017.00024 sha: 25c88fafba786f31d034614ba0f6efce5c687594 doc_id: 725987 cord_uid: dfu0tlsg BACKGROUND: Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest. The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs) and the current level of cardiopulmonary arrest rate in tertiary hospitals. METHODS: This was a retrospective study based on data from 14 tertiary hospitals. Cardiopulmonary resuscitation (CPR) rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present. RESULTS: Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009). Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854). National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001). High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001) and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001). CONCLUSIONS: RRSs may be a feasible option to reduce the CPR rate. The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics. Implementing a Sepsis Resuscitation Bundle Improved Clinical Outcome: A Before-and-After Study ( [1] [2] [3] [4] [5] [6] . Accordingly, early recognition of the signs and symptoms of deterioration could reduce the incidence of cardiopulmonary arrest, and this is the basis of rapid response systems (RRSs) [7, 8] . In Korea, RRS implementation has been targeted at large academic medical centers. Although there have been some single-center studies, no nationwide survey has investigated the effect of RRSs on in-hospital cardiopulmonary arrest in Korea. Therefore, it is still necessary to estimate the effect of RRSs on cardiopulmonary arrest in domestic hospitals. Two general hospitals in Korea implemented RRSs in 2014. The present study aimed to compare in-hospital cardiopulmonary arrest rates of institutions with or with-out RRSs, as well as to determine the cardiopulmonary arrest rates both before and after RRS implementation. We also used a pilot study to ascertain the prevalence of in-hospital cardiopulmonary arrest at tertiary hospitals, which was followed with a nationwide survey. This was a retrospective, multi-center study that used in-hospital cardiopulmonary arrest data from 14 tertiary hospitals from January 2013 to December 2015. Among the existing 43 tertiary hospitals nationwide, the study included data from two institutions with RRSs and 12 facilities without RRSs. We excluded two hospitals with more than 1,500 beds and one hospital with less than 700 beds. We also excluded five hospitals that had introduced an RRS before January 2013 and two hospitals that implemented an RRS after January 2015 ( Figure 1 ). From the remaining 33 hospitals, we selected 16 medi- annual adult admissions (the median value among the 14 hospitals) as "high-volume hospitals" and those with less than 32,000 annual adult admissions as "medium-volume hospitals." The The characteristics of the 14 hospitals are presented We compared the cardiopulmonary arrest rates between the hospitals with an RRS and those without it ( Figure 2 ). Hospitals with an RRS showed a statistically significant We verified the in-hospital cardiopulmonary arrest rates of hospitals based on affiliation (national vs. private), location (capital vs. provincial), and volume (highvolume vs. medium-volume). We additionally excluded three hospitals that did not use an EMR in 2013 to avoid selection bias. Therefore, all included hospitals utilized an EMR during the period of interest (Table 3) . 3.20, respectively; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001) ( Figure 4C ). Prior studies have suggested that in-hospital mortality is not an appropriate indicator of hospital service or quality given that patient populations vary widely among hospitals, and a comparison of mortality without any correction for selection bias could skew such analyses [10] [11] [12] . Nonetheless, the number of in-hospital cardiopulmonary arrests can be reduced with proper interventions; this is a hot topic of interest for administrators and [1, 13, 14] . RRSs have been widely adopted around the world over the past two decades and effectively reduce in-hospital cardiopulmonary arrests [13] [14] [15] [16] [17] [18] . RRSs can diminish inhospital cardiopulmonary arrests and improve patient Hence, it is possible that some data are not apparent from the accessible CPR cases. Nevertheless, the aim of this research was to determine the incidence of cardiopul-monary arrest, not to analyze its causes. It was also not intended to be a comparative analysis that reflected various variables and characteristics of each hospital. Finally, this study was designed as a before and after study, and it is challenging to conduct randomized controlled trials in this manner. The implementation of an RRS in two tertiary hospitals reduced the incidence of cardiopulmonary arrest over 3 years. Although we cannot conclude that RRSs are the only method that can be used to reduce cardiopulmonary arrest, they might be a practical option to use to achieve this goal. The discrepancies in cardiopulmonary arrest rate submitted for this survey suggest that a nationwide survey on cardiopulmonary arrest and the effect of RRSs is necessary. Promoting patient safety and healthcare quality is within the public domain. Therefore, hospital administrators should take an interest in encouraging and supporting the implementation of RRSs. 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Lessons from the NCEPOD cardiopulmonary resuscitation report 2012 We are grateful to the rapid response teams at Chungnam National University Hospital and Ulsan University Hospital for their key role in this work. The online-only Supplement data are available with this article online: https://doi.org/10.4266/kjccm.2017.00024.