Findings from a decade of experience following implementation of a Rapid Response System into an Asian hospital

Augustine Tee; Bryan Peide Choo; Roshni Sadashiv Gokhale; Xiqin Wang; Mashithah Mansor; Hong Choon Oh; Daryl Jones

doi:10.1016/j.resplu.2023.100461

Findings from a decade of experience following implementation of a Rapid Response System into an Asian hospital

Resusc Plus. 2023 Sep 1:16:100461. doi: 10.1016/j.resplu.2023.100461. eCollection 2023 Dec.

Authors

Augustine Tee¹, Bryan Peide Choo², Roshni Sadashiv Gokhale³, Xiqin Wang⁴, Mashithah Mansor⁵, Hong Choon Oh², Daryl Jones⁶

Affiliations

¹ Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
² Health Services Research, Changi General Hospital, Singapore.
³ Internal Medicine, Changi General Hospital, Singapore.
⁴ Advanced Practice Nurse Development, Changi General Hospital, Singapore.
⁵ MICU Ward, Changi General Hospital, Singapore.
⁶ Department of Intensive Care Unit, Austin Hospital, Australia.

Abstract

Aim: Rapid response systems (RRS) are present in many acute hospitals in western nations but are not widely adopted in Asia. The influence of healthcare culture and the effect of implementing an RRS over time are infrequently reported. We describe the introduction a RRS into a Singaporean hospital and the barriers encountered. The efferent limb activation rates, cardiac arrest rates and unplanned intensive care unit (ICU) admissions are trended over eleven years.

Methods: We conducted a retrospective observational study using prospectively collected data derived from administrative and Medical Emergency Team (MET) databases.

Results: The RRS used a MET with a single parameter track and trigger and physician led efferent limb. Barriers encountered included clinical leadership buy-in, assembling and equipping the efferent team, maintaining a non-punitive mindset, improving accessibility to MET and communicating the impact of the MET. Over an 11-year period with 488,252 hospital admissions, MET activation rates increased from 1.6/1000 admissions (2009) to 14.1/1000 admissions (2019). Code blue activations and unplanned ICU admission rates decreased from 2.9 to 1.7 and from 8.8 to 2.0/1000 admissions, respectively over the 11 years. There were associations between increasing MET activation rate and reduction in code blue activations (p = 0.013) and unplanned medical ICU admission rates (p = 0.001).

Conclusion: Implementing, sustaining and continued improvement of an RRS in Singapore is possible despite challenges encountered. With increasing activation rates over a decade, there were reductions in cardiac arrest rates and unplanned medical ICU admissions.

Keywords: Cardiac arrest; Code blue; Intensive care unit; Medical emergency team; Observational study; Rapid response system.