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Education, Teaching, and Quality Improvement |

Rapid Response Systems and the Return of Spontaneous Circulation After Inpatient Cardiopulmonary Arrest: More Than Meets the Eye

Christopher Hogan, MD; Markos Kashiouris, MD; James Tormey, RN; Sammy Pedram, MD; Sarah Hartigan, MD; Shannon Lubin, CCRN; Curtis Sessler, MD
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Virginia Commonwealth University, Richmond, VA


Chest. 2015;148(4_MeetingAbstracts):493A. doi:10.1378/chest.2281375
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Abstract

SESSION TITLE: Quality Improvement to Improve Patient Safety and Reduce Healthcare Costs

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM

PURPOSE: To evaluate the impact of rapid response system (RRS) activation on the prevalence of subsequent cardiopulmonary arrest (CPA) and return of spontaneous circulation (ROSC).

METHODS: We examined all RRS activations and all adult CPA events between October 2014 and March 2015 using data prospectively documented in an electronic database. The RRS team goes to all the CPA codes. We investigated the associations of the Early Warning System (EWS) score and prior RRS encounter, with the prevalence of inpatient CPA events and subsequent ROSC.

RESULTS: In the six-month study period, the RRS team remotely evaluated 1271 patients with high EWS scores and visited 948 ward patients. 25% (235/928) of those evaluations were influenced by high EWS screening. The rest of the RRS visits were triggered by a bedside nurse concern. The RRS team was present in 34 CPA events (one patient was excluded because of DNR status). 97% of those patients (33/34) had ROSC after the CPA event. The RRS team had evaluated the patient prior to the CPA event in only 24% (8/34) of the patients. 50% (4/8) of those patients were detected by the EWS.

CONCLUSIONS: Despite the large number of RRS patients evaluated, the vast majority of patients who experienced an inpatient CPA event were not detected by the RRS, or the EWS screening mechanisms prior to the CPA event. With the RRS team present in the code response, the rate of ROSC after CPA event was very high.

CLINICAL IMPLICATIONS: The majority of the patients who experienced an inpatient CPA event, were missed by the RRS “radar” and were never seen by the RRS team. Future studies evaluating RRS effectiveness should take this finding into consideration. Furthermore, we highlight the need for the development of higher performing electronic surveillance systems, tailored to the needs of the rapid response assessment.

DISCLOSURE: The following authors have nothing to disclose: Christopher Hogan, Markos Kashiouris, James Tormey, Sammy Pedram, Sarah Hartigan, Shannon Lubin, Curtis Sessler

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