Unique rapid response system with emergency call using an inhospital whole paging system
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KeywordsCardiopulmonary Arrest Hospital Death Rate Regular System Basic Life Support Emergency Call
The system of an inhospital rapid response team (RRT) is desired to be set up. Our hospital adopted a unique rapid response system (RRS) constructed with two different systems (organized and systematic system to activate RRT members, and nonorganized and nonsystematic system to gather doctors and nurses near the scene) with an inhospital whole paging system (doctor call (DC)). The object of this study is to clarify the usefulness and problems of our RRS.
We examined the records of 55 patients enrolled in our RRS for the past 2.5 years and evaluated the change of the death rate in whole discharged patients before and after the establishment of the RRS. Our unique RRS is as follows. A hospital staff member who finds a collapsed patient/visitor or a patient/visitor requiring urgent medical support or another staff near the scene calls the inhospital whole paging system (DC), which is announced in all areas of the hospital. Staff of the Critical Care and Emergency Center (CCE Center) bring an automated extracorporeal defibrillator and one bag prepared for the emergency crisis for one person. Other staff near the scene bring a monitor, oxygen, emergency cart and stretcher. We established an inhospital educational course for basic life support and basic resuscitation skill and a self-educating system using an e-learning system.
The events mainly occurred in the diagnostic and treatment room, waiting area, examination room for blood sampling or X-ray examination in the outpatient department (55%) and in the lavatory (5%). They seldom occurred in the critical care area (2%). The reasons why bystanders decided to start up the RRS are suspected cardiac arrest (13%), loss of consciousness (18%), witnessed falling down (31%), and lying down (16%). The mean time interval between the event and DC is 0.96 and that between the event and responding staff arrival at the scene is 1.81 minutes, respectively. The definitive diagnoses were cardiopulmonary arrest in 15%, cardiac event in 5% and psychiatric in 27%. In nine cardiopulmonary arrest cases, 33% were identified as an indication of resuscitation because of 'do not attempt resuscitation' during activity. The RRT managed 59% of the patients within 1.1 minutes. Both the hospital death rate per total discharged patients and that excepting patients treated in our CCE Center showed a decreasing tendency after official organization in the hospital as a regular system.
Our unique RRS is thought to work well. However, it needs to be helped by other doctors working nearer the scene than the RRT.
This article is published under license to BioMed Central Ltd.