Clinical emergencies and outcomes in patients admitted to a surgical versus medical service.
BACKGROUND
The merit of rapid response systems (RRSs) remains controversial. A tailored approach to specific groups may increase the efficacy of these teams. The purpose of this study was to compare differences in triggers for RRS activation, interventions, and outcomes in patients on medical and surgical services.


METHODS
A retrospective review RRS events was performed. The incidence of out of ICU cardiac arrests and hospital mortality were compared 2 years prior to and following RRS implementation. Call trigger, interventions, and disposition between medical and surgical patients were compared over a 15 month period.


RESULTS
Out of ICU cardiac arrest was significantly more prevalent in the medical group both before and after implementation of RRS. The out of ICU cardiac arrest rate decreased 32% in the surgical group (p=0.05) but hospital mortality did not change. Out of ICU cardiac arrest decreased 40% in the medical group (p<0.001) and hospital mortality decreased 25% (p<0.001) following RRS implementation. There were 1082 RRS activations, 286 surgical and 796 medical. Surgical patients were more likely to have received sedation within 24 h of evaluation (14% vs. 4%, p<0.001). The majority of patients in both cohorts were discharged alive.


CONCLUSIONS
Implementation of a RRS had greater impact on reduction of out of ICU cardiac arrest and mortality in medical inpatients. Triggers for activation and interventions were similar between groups; however, surgical patients demonstrated substantial risk for decompensation within the first 24 h following operation. More research is needed to evaluate the disproportionate benefit observed between cohorts.
Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania, United States. saranib@uphs.upenn.edu
Babak
B
Sarani
Emily
E
Palilonis
Seema
S
Sonnad
Meredith
M
Bergey
Carrie
C
Sims
Jose L
JL
Pascual
William
W
Schweickert
D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004638:Emergency Treatment / Q000592:standards*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors