Characteristics and outcomes of patients screened by the rapid response team and transferred to intensive care unit in South Korea

Introduction

In a significant push towards enhancing patient safety and reducing in-hospital mortality, rapid response systems (RRS) have become an essential component of hospital care in South Korea. These systems, designed to intervene early in cases of patient deterioration, have shown remarkable effectiveness in preventing adverse events and improving treatment outcomes. This article delves into the characteristics and outcomes of patients screened by the RRS and transferred to intensive care units (ICUs) in South Korea, highlighting their crucial role in modern healthcare.

The Role of Rapid Response Systems

Rapid response systems are designed to identify patients at risk of deterioration and provide timely interventions. These systems typically consist of an afferent limb (detection) and an efferent limb (intervention). The afferent limb involves monitoring patient vital signs, using scoring systems like the Modified Early Warning Score (MEWS), and receiving direct calls from healthcare providers. The efferent limb involves a specialized team of doctors and nurses who quickly respond to the identified risks, implementing interventions such as oxygen supplementation, airway management, and central venous line insertion.

Characteristics of Patients Screened by RRS

Studies have shown that patients transferred to ICUs following RRS activation often exhibit severe clinical conditions. Key characteristics include:

• Respiratory Distress: The most common cause of RRS activation, accounting for approximately 38% of cases.
• Sepsis and Septic Shock: These conditions were responsible for 10.7% of RRS activations, highlighting the critical need for early intervention in cases of infection.
• Cardiac Arrest and Cardiogenic Shock: These conditions were less frequent but still significant, occurring in 1.9% of cases in general wards and 8% in ICUs.
• High Disease Severity: Patients transferred to ICUs had higher SOFA and NEWS scores, indicating severe disease.

Outcomes of RRS Interventions

The interventions provided by RRSs are critical in determining patient outcomes. Key outcomes include:

• Survival Rates: After RRS activation, patient survival rates were found to be approximately 83.6%.
• ICU Transfers: Approximately 20-40% of patients activated by RRSs were transferred to ICUs for further critical care.
• Interventions: Patients transferred to ICUs received a range of interventions including endotracheal intubation, vasopressors, central venous access, and hemodynamic monitoring.
• Length of Hospital Stay: Patients requiring ICU admission had longer hospitalization times prior to RRS activation, indicating a more prolonged clinical course.

Quality Improvement and Feedback

The success of RRSs depends on continuous quality improvement and feedback. Key strategies include:

• Regular Evaluations: Regular evaluations using objective metrics are essential to guide self-evaluation within the team. External evaluations are also crucial for overall improvement.
• Feedback Mechanisms: Weekly or biweekly team meetings are vital for discussing each case that activated the RRT, identifying failures, and providing feedback.
• Objective Metrics: Ten quality metrics have been proposed to evaluate an RRS, focusing on outcomes such as cardiac arrests in general wards, timeliness of responses, and critical care interventions.

Administrative Support

Effective administration is critical for the successful implementation and maintenance of RRSs. This includes:

• Funding Support: Proper funding support is necessary to implement both the afferent and efferent limbs of the RRS. This involves coordinating resources for staffing, equipment, and education.
• National Support: In South Korea, national support has been significant. The Korean Health Insurance Review & Assessment Service and Ministry of Health and Welfare have initiated pilot programs to expand RRS implementation, providing financial incentives to hospitals with more than 300 beds.

Conclusion

Rapid response systems have revolutionized patient care in South Korea by providing timely interventions that significantly reduce in-hospital mortality and improve treatment outcomes. The characteristics of patients screened by RRSs, such as respiratory distress and sepsis, highlight the critical need for these systems. Continuous quality improvement through regular evaluations and feedback mechanisms ensures that RRSs remain effective. Administrative support, including funding and national initiatives, is essential for the widespread adoption and maintenance of these life-saving systems.

By understanding the role and impact of RRSs, we can better appreciate the strides being made in patient safety and healthcare quality. As healthcare continues to evolve, it is clear that rapid response systems will remain a cornerstone in the fight against preventable hospital deaths.

References

1. Strategies for successful implementation and permanent maintenance of a rapid response system
2. Epidemiology and Clinical Characteristics of Rapid Response Team
3. Characteristics and outcomes of patients screened by the rapid response team
4. Rapid response systems in Korea