title: Mature rapid response system and potentially avoidable cardiopulmonary arrests in hospital.
abstract: OBJECTIVE
  To study the incidence, outcome and potentially avoidable causes of inpatient cardiopulmonary arrests in a hospital with a "mature" rapid response system (RRS).
  
  
  METHODS
  Retrospective observational study of all cardiopulmonary arrest events in 2005.
  
  
  METHODS
  University of Pittsburgh Medical Center Presbyterian Hospital, a 730-bed academic, urban, tertiary care adult hospital in the USA.
  
  
  METHODS
  None.
  
  
  RESULTS
  During the calendar year 2005, the 16th year since the establishment of a medical emergency team (MET)/RRS, the MET was activated 1942 times; 111 of these events were cardiopulmonary arrest events (3.26 arrest events/1000 patient admissions), and 1831 were non-arrest patient crisis events (53.8 crisis events/1000 patient admissions). A review of the 104 index cardiopulmonary arrest events revealed that 26 (25%) patients survived to discharge. Event survival decreased as the intensity of patient monitoring decreased (83% in intensive care units, 69% in monitored, and 36% in unmonitored units; p = 0.002), but the rate of subsequent in-hospital death was higher in the more intensely monitored settings (60%, 38%, 23%, respectively; p = 0.022). Nineteen (18%) arrests were deemed to be "potentially avoidable". Avoidable arrests were classified as: failure to adhere to established hospital patient care guideline or policy; inadequate monitoring or surveillance; or delays in dealing with patient needs including delay in MET/RRS activation.
  
  
  CONCLUSIONS
  In spite of the high crisis event rate and a low rate of cardiac arrests, potentially avoidable cardiopulmonary arrests still occurred. According to the present study more cardiopulmonary arrest events might be avoided by better adherence to hospital patient care policies, by closer monitoring on floors and by preventing delays in addressing deterioration in patient condition.
authors: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors: Sanjay
authors: S
authors: Galhotra
authors: Michael A
authors: MA
authors: DeVita
authors: Richard L
authors: RL
authors: Simmons
authors: Mary Amanda
authors: MA
authors: Dew
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000401:mortality* / Q000517:prevention & control*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D010348:Patient Care Team / Q000592:standards*; D010414:Pennsylvania / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D016019:Survival Analysis
references: Lancet. 1975 Mar 1;1(7905):480-4
references: 46957
references: Qual Saf Health Care. 2004 Aug;13(4):255-9
references: 15289627
references: Can J Cardiol. 1991 Apr;7(3):113-6
references: 2044012
references: J Am Board Fam Pract. 1993 Mar-Apr;6(2):91-101
references: 8452077
references: Resuscitation. 1998 Jun;37(3):133-7
references: 9715771
references: Acta Anaesthesiol Scand. 2005 May;49(5):702-6
references: 15836688
references: Lancet. 2005 Jun 18-24;365(9477):2091-7
references: 15964445
references: Qual Saf Health Care. 2005 Oct;14(5):326-31
references: 16195564
references: Crit Care. 2005;9(6):R808-15
references: 16356230
references: JAMA. 2006 Jan 4;295(1):50-7
references: 16391216
references: JAMA. 2006 Jan 18;295(3):324-7
references: 16418469
references: Crit Care Med. 2006 Jun;34(6):1700-6
references: 16625132
references: Crit Care Med. 2006 Sep;34(9):2463-78
references: 16878033
references: Intensive Care Med. 2006 Sep;32(9):1352-6
references: 16826391
references: Resuscitation. 2001 Feb;48(2):125-35
references: 11426474
references: Arch Intern Med. 2001 Jul 23;161(14):1751-8
references: 11485508
references: BMJ. 2002 Feb 16;324(7334):387-90
references: 11850367
references: Resuscitation. 2002 Aug;54(2):115-23
references: 12161290
references: J Crit Care. 2003 Jun;18(2):87-94
references: 12800118
references: Med J Aust. 2003 Sep 15;179(6):283-7
references: 12964909
references: Resuscitation. 2003 Sep;58(3):297-308
references: 12969608
references: Qual Saf Health Care. 2004 Aug;13(4):251-4
references: 15289626
references: Chest. 1990 Dec;98(6):1388-92
references: 2245680