Abstract
BackgroundRapid response systems (RRSs) improve patients’ safety, but the role of dedicated doctors within these systems remains controversial. We aimed to evaluate patient survival rates and differences in types of interventions performed depending on the presence of dedicated doctors in the RRS.MethodsPatients managed by the RRSs of 9 centers in South Korea from January 1, 2016, through December 31, 2017, were included retrospectively. We used propensity score-matched analysis to balance patients according to the presence of dedicated doctors in the RRS. The primary outcome was in-hospital survival. The secondary outcomes were the incidence of interventions performed. A sensitivity analysis was performed with the subgroup of patients diagnosed with sepsis or septic shock.ResultsAfter propensity score matching, 2981 patients were included per group according to the presence of dedicated doctors in the RRS. The presence of the dedicated doctors was not associated with patients’ overall likelihood of survival (hazard ratio for death 1.05, 95% confidence interval [CI] 0.93‒1.20). Interventions, such as arterial line insertion (odds ratio [OR] 25.33, 95% CI 15.12‒42.44) and kidney replacement therapy (OR 10.77, 95% CI 6.10‒19.01), were more commonly performed for patients detected using RRS with dedicated doctors. The presence of dedicated doctors in the RRS was associated with better survival of patients with sepsis or septic shock (hazard ratio for death 0.62, 95% CI 0.39‒0.98) and lower intensive care unit admission rates (OR 0.53, 95% CI 0.37‒0.75).ConclusionsThe presence of dedicated doctors within the RRS was not associated with better survival in the overall population but with better survival and lower intensive care unit admission rates for patients with sepsis or septic shock.
Highlights
Rapid response systems (RRSs) improve patients’ safety, but the role of dedicated doctors within these systems remains controversial
Patients detected by the RRS with dedicated doctors were younger than those detected by the RSS without any dedicated
Excluded - RRS Activation reason not specified (n = 2,673) - Missing values of Modified Early Warning Score (MEWS) (n = 564) - Missing values of BMI (n = 257) - RRS Activated for education (n = 202) - Still hospitalized (n = 27) - RRS Activated for transfer (n = 7)
Summary
Rapid response systems (RRSs) improve patients’ safety, but the role of dedicated doctors within these systems remains controversial. We aimed to evaluate patient survival rates and differences in types of interventions performed depending on the presence of dedicated doctors in the RRS. RRS have been widely deployed after the 100,000 Lives Campaign to reduce the number of preventable deaths [3]. Their implementation can reduce hospital mortality rates and non-intensive care unit (ICU) cardiopulmonary arrests [4]. Nurse practitioners are a reasonable substitute for medical doctors in some emergency care activities, suggesting hospitals may consider the cost-effectiveness of including dedicated doctors in the RRS, as some of their duties can be effectively performed by nurses [9]
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