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Kang BJ, Hong SB, Jeon K, Lee SM, Lee DH, Moon JY, Lee YJ, Kim JS, Park J, Ahn JJ. Rapid Response System Should Be Enhanced at Non-general Ward Locations: a Retrospective Multicenter Cohort Study in Korea. J Korean Med Sci 2021; 36:e7. [PMID: 33429471 PMCID: PMC7801145 DOI: 10.3346/jkms.2021.36.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A rapid response system (RRS) contributes to the safety of hospitalized patients. Clinical deterioration may occur in the general ward (GW) or in non-GW locations such as radiology or dialysis units. However, there are few studies regarding RRS activation in non-GW locations. This study aimed to compare the clinical characteristics and outcomes of patients with RRS activation in non-GW locations and in the GW. METHODS From January 2016 to December 2017, all patients requiring RRS activation in nine South Korean hospitals were retrospectively enrolled and classified according to RRS activation location: GW vs non-GW RRS activations. RESULTS In total, 12,793 patients were enrolled; 222 (1.7%) were non-GW RRS activations. There were more instances of shock (11.6% vs. 18.5%) and cardiac arrest (2.7% vs. 22.5%) in non-GW RRS activation patients. These patients also had a lower oxygen saturation (92.6% ± 8.6% vs. 88.7% ± 14.3%, P < 0.001) and a higher National Early Warning Score 2 (7.5 ± 3.4 vs. 8.9 ± 3.8, P < 0.001) than GW RRS activation patients. Although non-GW RRS activation patients received more intubation (odds ratio [OR], 3.135; P < 0.001), advanced cardiovascular life support (OR, 3.912; P < 0.001), and intensive care unit transfer (OR, 2.502; P < 0.001), their hospital mortality (hazard ratio, 0.630; P = 0.013) was lower than GW RRS activation patients upon multivariate analysis. CONCLUSION Considering that there were more critically ill but recoverable cases in non-GW locations, active RRS involvement should be required in such locations.
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Affiliation(s)
- Byung Ju Kang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jisoo Park
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| | - Jong Joon Ahn
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Engebretsen S, Bogstrand ST, Jacobsen D, Rimstad R. Characteristics, management and outcome of critically ill general medical patients in the Emergency Department: An observational study. Int Emerg Nurs 2020; 54:100939. [PMID: 33302239 DOI: 10.1016/j.ienj.2020.100939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Critically ill general medical patients are an increasing group in the Emergency Department (ED). This register-based cohort study aimed to examine these patients' characteristics, ED management and outcome, and investigate factors associated with ICU admission. METHODS The study comprised all adult medical triage 1 patients treated by a specialized multidisciplinary team in 2015 and 2016. Univariate and multivariate analysis were used. RESULTS 1294 patients were included. Mean age was 59 years, 56% (n = 725) were male, mean National Early Warning Score 2 (NEWS2) was 7, intensive care unit (ICU) admission was 56.8% (n = 735) and mortality rate was 16.8% (n = 217). Median ED length of stay (LOS) was 1.6 h, 1.2 h if admitted to ICU. The most frequent discharge diagnosis was acute poisoning (24.0%, n = 308). Younger age, male gender, arriving at nighttime weekdays, higher NEWS2 at arrival, critical care interventions or medications in the ED was associated with ICU admission. CONCLUSION More than half of the patients were admitted to ICU, and the mortality rate was 16.8%. A large proportion was diagnosed with acute poisoning. Younger age, higher NEWS and critical care in ED were associated with ICU admission. The short ED LOS suggests that management by a multidisciplinary team is beneficial.
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Affiliation(s)
- Stine Engebretsen
- Emergency Department, Division of Emergencies and Critical Care, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway.
| | - Dag Jacobsen
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
| | - Rune Rimstad
- Medicine, Health, Patient Safety and Integration, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
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Shahjouei S, Bavarsad-Shahripour R, Assarzadegan F, Rikhtegar R, Mehrpour M, Zamani B, Tsivgoulis G, Alexandrov A, Alexandrov A, Zand R. Acute management of stroke in Iran: Obstacles and solutions. Iran J Neurol 2017; 16:62-71. [PMID: 28761627 PMCID: PMC5526779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/16/2017] [Indexed: 11/04/2022]
Abstract
Background: Stroke is among the leading causes of mortality and permanent disability in the world. Iran is located in the stroke belt and has a high age-adjusted stroke incidence rate. In this multistep prospective qualitative study, we aimed at investigating the status and challenges of stroke management in Iran and explore possible solutions. Methods: In the first and second phase, we attempted to define the status of stroke management in Iran by searching the relevant literature and conducting semi-structured interviews with health-care providers in thirteen hospitals located in seven large cities in Iran. In the third phase, we tried to recommend possible solutions based on international standards and experience, as well as interviews with stroke experts in Iran and the United States. Results: Little public awareness of stroke symptoms and its urgency, low prioritization for stroke management, and an inadequate number of stroke-ready hospitals are some of the major obstacles toward timely treatment of stroke in Iran. Every hospital in our pool except two hospitals had guideline-based algorithms for the administration of intravenous thrombolysis. However, there was no single call activation system for stroke alert. Data from some of the centers showed that hospital arrival of stroke patients to final decision-making took 116-160 minutes. Although there were four endovascular programs in our target areas, there was no center with 24-hour coverage. Conclusion: There are many challenges as well as potentials for improvement of stroke care in Iran. Improving public knowledge of stroke and establishing an organized and comprehensive stroke program in the hospitals will improve acute stroke management in Iran. The Iranian ministry of health should define and advocate the establishment of stroke centers, track the rate of death and disability from stroke, introduce pathways to improve the quality of stroke care through national data monitoring systems, and eliminate disparities in stroke care.
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Affiliation(s)
- Shima Shahjouei
- Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farhad Assarzadegan
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rikhtegar
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Mehrpour
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Zamani
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Andrei Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anne Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ramin Zand
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurology, Geisinger Health System, Danville, Pennsylvania, USA
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Lee YJ, Lee DS, Min H, Choi YY, Lee EY, Song I, Yoon YE, Kim JW, Park JS, Cho YJ, Lee JH, Suh JW, Jo YH, Kim K, Park S. Differences in the Clinical Characteristics of Rapid Response System Activation in Patients Admitted to Medical or Surgical Services. J Korean Med Sci 2017; 32:688-694. [PMID: 28244298 PMCID: PMC5334170 DOI: 10.3346/jkms.2017.32.4.688] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/28/2016] [Indexed: 11/20/2022] Open
Abstract
Variability in rapid response system (RRS) characteristics based on the admitted wards is unknown. We aimed to compare differences in the clinical characteristics of RRS activation between patients admitted to medical versus surgical services. We reviewed patients admitted to the hospital who were detected by the RRS from October 2012 to February 2014 at a tertiary care academic hospital. We compared the triggers for RRS activation, interventions performed, and outcomes of the 2 patient groups. The RRS was activated for 460 patients, and the activation rate was almost 2.3 times higher for surgical services than that for medical services (70% vs. 30%). The triggers for RRS activation significantly differed between patient groups (P = 0.001). They included abnormal values for the respiratory rate (23.2%) and blood gas analysis (20.3%), and low blood pressure (18.8%) in the medical group; and low blood pressure (32.0%), low oxygen saturation (20.8%), and an abnormal heart rate (17.7%) in the surgical group. Patients were more likely classified as do not resuscitate or required intensive care unit admission in the medical group compared to those in the surgical group (65.3% vs. 54.7%, P = 0.045). In multivariate analysis, whether the patient belongs to medical services was found to be an independent predictor of mortality after adjusting for the modified early warning score, Charlson comorbidity index, and intervention performed by the RRS team. Our data suggest that RRS triggers, interventions, and outcomes greatly differ between patient groups. Further research is needed to evaluate the efficacy of an RRS approach tailored to specific patient groups.
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Affiliation(s)
- Yeon Joo Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Seon Lee
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunju Min
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Young Choi
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Young Lee
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Inae Song
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Sun Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jae Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangheon Park
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.
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Ha SW, Choi YJ, Lee SE, Chi SI, Kim HJ, Han JH, Han HJ, Lee EH, Kim HJ, Seo KS. Emergency response team activation in the outpatient clinic of a single dental teaching hospital in Korea: a retrospective study of 10 years' records. J Dent Anesth Pain Med 2015; 15:77-83. [PMID: 28879262 PMCID: PMC5564102 DOI: 10.17245/jdapm.2015.15.2.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 11/29/2022] Open
Abstract
Background To prepare for possible emergency situations during dental treatment, it is helpful to know how often and what kinds of emergencies may arise. This study set out to evaluate the incidences, causes, treatments, and outcomes of emergency situations in the outpatient clinic of a dental teaching hospital in Korea. Methods We retrospectively reviewed the records of patients who had experienced an emergency situation and emergency response team activated in a selected outpatient clinic between November 2004 and November 2013. Specific information about the emergency cases was collected, including the patient characteristics and the frequency, types, treatments, and outcomes of the emergency situations. Results We identified 35 instances of emergency situations in 2,890,424 patients (incidence = 0.012 per 10,000 outpatients). The number of cases was as follows: 10 (28.6%) in the Department of Periodontics, 10 (28.6%) in the Department of Oral and Maxillofacial Surgery, 6 (17.1%) in the Department of Oral and Maxillofacial Radiology, 4 (11.4%) in the Department of Prosthodontics, 2 (5.7%) in the Department of Conservative Dentistry, 2 (5.7%) in the Department of Pediatric Dentistry, and 1 (2.9%) in the Department of Orthodontics. Three (8.6%) of the emergency situations arose before treatment, 22 (62.9%) during treatment, 7 (20.0%) after treatment, and 2 (5.7%) in a patient's guardian. Conclusions In accordance with the growing elderly population and more aggressive dental procedures, the number of emergency situations may increase in the future. We recommend that clinicians keep in mind airway management and the active control of emergency situations.
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Affiliation(s)
- Sang Woon Ha
- School of Dentistry, Seoul National University, Seoul, Korea
| | - Yoon Ji Choi
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Soo Eon Lee
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Seong In Chi
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Hye-Jung Kim
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Jin-Hee Han
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Hee-Jeong Han
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Eun-Hee Lee
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Mora JC, Schneider A, Robbins R, Bailey M, Bebee B, Hsiao YFF, Considine J, Jones D, Bellomo R. Epidemiology of early Rapid Response Team activation after Emergency Department admission. ACTA ACUST UNITED AC 2015; 19:54-61. [PMID: 26071173 DOI: 10.1016/j.aenj.2015.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rapid Response Team (RRT) calls can often occur within 24h of hospital admission to a general ward. We seek to determine whether it is possible to identify these patients before there is a significant clinical deterioration. METHODS Retrospective case-controlled study comparing patient characteristics, vital signs, and hospital outcomes in patients triggering RRT activation within 24h of ED admission (cases) with matched ED admissions not receiving a RRT call (controls). RESULTS Over 12 months, there were 154 early RRT calls. Compared with controls, cases had a higher heart rate (HR) at triage (92 vs. 84 beats/min; p=0.008); after 3h in the ED (91 vs. 80 beats/min; p=0.0007); and at ED discharge (91 vs. 81 beats/min; p=0.0005). Respiratory rate (RR) was also higher at triage (21.2 vs. 19.2 breaths/min; p=0.001). On multiple variable analysis, RR at triage and HR before ward transfer predicted early RRT activation: OR 1.07 [95% CI 1.02-1.12] for each 1 breath/min increase in RR; and 1.02 [95% CI 1.002-1.030] for each beat/minute increase in HR, respectively. Study patients required transfer to the intensive care in approximately 20% of cases and also had a greater mortality: (21% vs. 6%; OR 4.65 [95% CI 1.86-11.65]; p=0.0003) compared with controls. CONCLUSIONS Patients that trigger RRT calls within 24h of admission have a fourfold increase in risk of in-hospital mortality. Such patients may be identified by greater tachycardia and tachypnoea in the ED.
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Affiliation(s)
- Juan Carlos Mora
- Department of Intensive Care, Austin Hospital, Melbourne, Australia.
| | | | - Raymond Robbins
- Department of Administrative Informatics, Austin Hospital, Melbourne, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
| | - Bronwyn Bebee
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | | | - Julie Considine
- Eastern Health - Deakin University Nursing and Midwifery Research Centre/Centre for Quality and Patient Safety Research, Deakin University, Burwood, Australia
| | - Daryl Jones
- Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
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Sabahi M, Fanaei SA, Ziaee SA, Falsafi FS. Efficacy of a rapid response team on reducing the incidence and mortality of unexpected cardiac arrests. Trauma Mon 2012; 17:270-4. [PMID: 24350104 PMCID: PMC3860642 DOI: 10.5812/traumamon.4170] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 05/28/2012] [Accepted: 05/29/2012] [Indexed: 12/03/2022] Open
Abstract
Background Rapid Response Teams (RRTs) assess patients during early phases of deterioration to reduce patient morbidity and mortality. Objectives This study aimed to evaluate the ability of earlier medical intervention by a RRT prompted by clinical instability in patients to reduce the incidence of and mortality from unexpected cardiac arrest at our hospital. Patients and Methods A nonrandomized, population-based study before 2008 and after 2010 introduction of the Rapid Response Teams in a 300 bed private hospital. All patients were admitted to the hospital in 2008 (n = 25348) and 2010 (n = 28024). RRT (One doctor, one senior intensive care nurse and one staff nurse) attended to clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response was activated by the bedside nurse or doctor according to predefined criteria. Main outcome measures were incidence and outcome of unexpected cardiac arrest. Results The incidence of unexpected cardiac arrest was 17 per 1000 hospital admissions (431 cases) in 2008 (before RRT intervention) and 12.45 per 1000 admissions (349 cases) in 2010 (after intervention), with mortality being 73.23% (274 patients) and 66.15% (231 patients) respectively. After adjustment for case mix the intervention was associated with a 19% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.81, 95% confidence interval 0.65-0.98). Conclusions The RRT was able to detect preventable adverse events and reduce the mortality and incidence of unexpected cardiac arrests.
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Affiliation(s)
- Majid Sabahi
- Faculty of University of Sunny Brook, CA ATLS Instructor by American College of Surgeons, Toronto, Canada
- Department of Emergency Medicine, Atieh Hospital, Tehran, IR Iran
| | - Seyed Ahmad Fanaei
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Seyed Ali Ziaee
- ATLS Instructor by American College of Surgeons, Emergency Department of Saudi German Hospital, Dubai, UAE
- Corresponding author: Seyed Ali Ziaee, ATLS Instructor by American College of Surgeons, Emergency Department of Saudi German Hospital, Dubai, UAE. Tel: +971502535951, Fax: +989127110014,
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