Rapid Response Team Research Articles

Abstract 329: Unrecognized Clinical Deterioration Prior to In-Hospital Cardiac Arrest and Associated In-Hospital Mortality

Introduction: Physiologic abnormalities often precede in-hospital cardiac arrest (IHCA). Critical Care Outreach Teams (CCOTs) are designed to respond to patients that meet standardized rapid response team (RRT) activation criteria including vital sign abnormalities, neurologic changes, and nursing concern. However, these systems often rely on clinical staff recognizing signs of clinical deterioration and initiating a rapid response. Research Question: The purpose of this post-hoc analysis was to identify if there was an in-hospital mortality difference between two different adult patient groups: 1) patients who met standardized RRT criteria but did not receive an RRT prior to IHCA and 2) patients who had no evidence of clinical deterioration prior to IHCA. Goals: The primary goal was to explore the association of unrecognized clinical deterioration on patient mortality. A secondary goal was to identify the timing onset of RRT criteria in patients who had an IHCA but did not receive an RRT activation. Methods: All non-ICU IHCAs during a 5-year period (January 1st, 2018, to December 31st, 2022) were reviewed to identify whether: 1) standardized RRT criteria had been met in the 24 hours prior to IHCA, 2) the onset of RRT criteria if present, 3) sustained return of spontaneous circulation (ROSC) occurred during the IHCA, and 4) if the patient died during their hospitalization. Results: There were 271 adult non-ICU IHCAs without a preceding RRT activation. Of those, 203 (79.4%) met RRT criteria prior to IHCA. In patients who had evidence of clinical deterioration, patients displayed at least one RRT criterion an average of 13.1 hours prior to IHCA. Sustained ROSC was higher in the patient group without RRT criteria (79.4%, 54/68 vs 72.9%, 148/203), but this was not significant. In-hospital mortality was significantly higher patients who met RRT criteria without RRT activation compared to patients who did not meet RRT criteria prior to IHCA (67.9%, 65/138 vs 54.4%, 31/37, p<0.05). Conclusions: Most patients who experienced an IHCA demonstrated physiologic abnormalities hours prior to IHCA. Patients who met RRT criteria without RRT activation had a significantly higher mortality rate when compared with patients who did not have evidence of clinical deterioration.

Abstract 13334: Safety of Chest Compressions in Patients With a Durable Left Ventricular Assist Device

Introduction: The safety of chest compressions (CC) during cardiopulmonary resuscitation (CPR) among pts with a durable left ventricular assist device (LVAD) is an area of controversy. Concerns regarding device malfunction or dislodgment with CC may result in significant delays or the withholding of life-sustaining intervention entirely. Current societal guidelines, based on small case reports, suggest that manual CC are probably not harmful, but offer no additional guidance. Furthermore, they acknowledge that there are no data regarding the use of machine-assisted CC. Methods: We retrospectively reviewed medical records of consecutive pts who underwent durable LVAD implantation at Duke University from 2013-2022. Charts were searched for “code”, “arrest”, “compressions”, and “rapid response team” to identify all instances of cardiac arrest (CA). Baseline pt characteristics, details of the arrest (including CC details), in-hospital care processes, and pt outcomes were abstracted. Results: Of 750 pts reviewed, 58 (mean age 64 years, 76% male, median LVAD support duration 19 months) had documented CA. Fifteen (26%) pts presented with an out-of-hospital CA. Twenty-four (41%) pts did not receive CC. The most commonly reported reason for avoiding CC was “LVAD in place - contraindicated.” The CPR duration was longer among those who received CC (median 30mins, range: 1-120 mins) than those who did not (median 20 mins, range: 2-79 mins). Two pts had support from a Lund University Cardiac Assist System (LUCAS) device. Among those who survived either manual and machine-assisted CC, 27% had a post-arrest TTE and none showed evidence of LVAD malfunction/dislodgment. Conclusions: Among pts with a durable LVAD who underwent CPR for CA we found no evidence of device dislodgment or safety concerns associated with either manual or LUCAS-assisted CPR. Future multicenter and prospective evaluation is necessary to both confirm these findings and to inform the guidelines.

Abstract 325: Two-Year Outcomes of an Electronic Health Record Integrated Rapid Response Team Model

Background: Literature supports improved patient outcomes with dedicated resources for rapid response to patient deterioration in inpatient settings. However, studies of the association of centralized resource allocation and electronic health record (EHR) integration on patient outcomes are lacking. Aim: To improve early, centralized rapid response to patient deterioration and reduce unanticipated transfers to the ICU. Methods: Using a prospective longitudinal quality improvement design, we implemented a centralized, EHR supported patient response team (PRT) at an academic medical center in the southeastern United States. The model served 1,043 inpatient beds. Pre-intervention the PRT used episodic data capture and included 1 critical care RN, 1 physician, and 1 respiratory therapist; each expected to leave assigned patients to respond to non-ICU events. We implemented a dedicated PRT (4 critical care RNs and 1 hospitalist) to provide 24/7 response to code blue, RRT, and stroke code events. The team provided proactive rounding, preventive consultation, and assessment of patients from ICU or emergency within 24 hours. Standardized workflow and outcome documentation was integrated in the EHR. Improvement in processes and outcomes were analyzed using statistical process control charts with 25 data points over a 2-year period. Results: At baseline (FY 2020), the PRT responded to 1739 rapid response calls and 166 code blue events. Unanticipated transfer to ICU occurred in 935 (53.8%) patients. Post-implementation of the integrated PRT model, the rate of early rapid response calls improved (FY 2021 n=2099; FY 2022 n=2239), code blue events decreased (FY 2021 n=151; FY 2022 n=115), and unanticipated ICU transfers also decreased (25%; Figure 1). Conclusions: A centralized PRT model using technology-supported EHR integration, pre-defined workflows, and a dedicated team can reduce non-ICU cardiac arrests and decrease unanticipated transfers to ICU.

Analysis of the application effect of a rapid response team in emergency cesarean section

Introduction Emergency cesarean section is one of the most critical methods in the treatment of high-risk emergency obstetric cases. The aim of this study was to explore the clinical effect of constructing a Rapid Response Team (RRT) in emergency cesarean section. Methods This is a pre- and post-implementation study. The patients who underwent emergency cesarean section were retrospectively analyzed and divided into an experimental group and a control group. There were 52 patients (June–December 2020) in the control group who underwent routine emergency cesarean section without an RRT, and 51 patients (January–June 2021) in the experimental group who underwent emergency cesarean section with an RRT. The operation time indexes (DOI, decision-to-operating room interval; O-I, operating room-to-incision interval; DII, decision-to-incision interval; I-D, incision-to-delivery interval; DDI, decision-to-delivery interval), DDI pass rate, neonatal Apgar score and maternal complications in the two groups were compared. Moreover, the management time trends (DOI, DII, and DDI) in the experimental group were analyzed. Results The DDI, DII, DOI, and O-I of the experimental group were shorter than those of the control group, and the differences were significant (p < 0.05). The DDI pass rate in the experimental group was higher than that in the control group, and the difference was significant (p < 0.01). The 1-min Apgar score of the experimental group was higher than that of the control group (p < 0.05). The key intervals of emergency cesarean section in the experimental group leveled off after approximately 3 to 4 months. Conclusion In the face of emergency situations, the implementation of an emergency cesarean section RRT can improve delivery intervals for emergency cesarean and would be conducive to maternal and infant safety.

Mind the gaps: Building communication bridges during medical codes

We describe the development and implementation of a program to identify and address gaps in code response at Memorial Sloan Kettering Cancer Center (MSKCC), a tertiary cancer center in New York City. The program aimed to assess the challenges faced by Rapid Response Team (RRT) and Medical Code Team (MCT) members, classify these challenges into medical knowledge/skills or team functioning/communication categories, develop a plan to address the identified challenges, and evaluate its effectiveness within the RRT/MCT teams. Based on survey responses and ongoing quality assurance (QA) reviews the two main challenges identified were chaos or crowd control and role identification. A tailored simulation-based training session was designed and implemented, leading to improved crowd management and the establishment of an ongoing training program.

Experiences of hospice dementia care: A qualitative study of bereaved carers and hospice clinicians.

Nearly 50 million people worldwide have dementia and the increasing numbers requiring end-of-life and palliative care, has led to national efforts to define standards of care for this patient group. Little research, however, has been done to date about the experience of hospice care for people with dementia accessing these services. This study explores the views of hospice dementia care for bereaved carers of people with dementia and hospice clinicians. We used purposive sampling for participant recruitment. Semi-structured qualitative interviews were conducted with bereaved carers and hospice clinical staff. Interviews were audio recorded and the transcriptions were analysed through thematic analysis. A total of 12 participants were interviewed from one service in the Northwest region in the UK. All were female and white British. Participants described their experience of hospice dementia care in three main themes: Pre-access to service, roles and responsibility within hospice care, ease and difficulty of last period of end-of-life care. Rapid response teams delivering hospice home care could represent a better option to inpatient care and may be preferred by patients. This type of service, however, may require joined-up care with other community services, and this type of care needs to be considered and planned. Future studies should evaluate this type of community care.

A Quality Improvement Project to Improve the Utilization of an Intraoperative Rapid Response System

Introduction: Rapid response teams (RRTs) improve morbidity by reducing the incidence of cardiac arrests. Although providers commonly activate RRTs on acute care wards, they are infrequently used perioperatively. At our institution, two intraoperative calls for help exist: staff assists (SAs) and code blues (CBs). The SA functions analogously to an RRT, and the CB indicates cardiopulmonary arrest. Given the success of RRTs, this project aimed to increase the use of the SA system. Our primary goal was to increase the ratio of SA to CB alerts by 50% within 6 months. Methods: A quality improvement team led this project at an academic pediatric hospital in Northern California. The team analyzed the current state and identified an achievable goal. After developing key drivers, they implemented monthly simulations to teach providers the signs of clinical deterioration and to practice activating the SA system. In addition to measuring the ratio of SA to CB alerts, the team surveyed the etiologies of SA and measured process satisfaction. Results: Before the introduction of this initiative, the ratio of SA to CB alerts were 1:13.3. These improvements efforts led to an increase of SA to CB alerts to 1.5:1 (P = 0.0003). Twenty-three anesthesiologists provided etiologies for SA, reporting laryngospasm as the most common reason (30.4%). Nineteen nurses completed the SA survey and reported high satisfaction. Conclusion: This project successfully increased the utilization of a rapid response protocol in a pediatric perioperative setting using improvement methodologies and a simulation-based educational program.

203 Impact of the operation of the response rapid response team(RRT) in Igualada University Hospital (IUH) during the 2012–2022 period

203 Impact of the operation of the response rapid response team(RRT) in Igualada University Hospital (IUH) during the 2012–2022 period

Effect of in situ simulation training for emergency caesarean section on maternal and infant outcomes

BackgroundEmergency caesarean section (ECS) is an effective method for rapid termination of pregnancy and for saving maternal and foetal life in emergencies. Experts recommend that the interval from decision of operation to the decision to delivery interval (DDI) should be shortened as much as possible. Studies have shown that improving communication skills among staff by performing simulation drills shortens DDI, thus reducing the occurrence of adverse obstetric events and protecting maternal and child safety. In situ simulation (ISS) training is a simulation-based training approach for clinical team members conducted in a real-world clinical setting. In August 2020, Anhui Maternal and Child Health Hospital began ISS training on the rapid obstetric response team (RRT) in our hospital area for emergency caesarean section. This study aimed to investigate the effect of implementing in situ simulation training for emergency caesarean section on maternal and child outcomes by comparing maternal and child-related data on emergency caesarean section in two hospital areas.MethodsData on cases of emergency caesarean delivery implemented in two hospital districts from August 2020 to August 2022 were collected: 19 in the untrained group and 26 in the training group. The two groups were compared concerning the interval from the decision of operation to the decision to delivery interval (DDI), the interval from the decision of operation to the initiation of skin incision, the interval from skin incision to the decision to delivery interval, and the neonatal situation.ResultsPrimary outcome comparison: The training group had a significantly shorter interval between the DDI compared to the untrained group (8.14 ± 3.13 vs. 11.03 ± 3.52, P = 0.006). Secondary outcomes comparison: The training group had a significantly shorter interval between the decision to cut skin compared to the untrained group (6.45 ± 2.21 vs. 9.95 ± 4.02, P = 0.001). However, there was no significant difference in the interval between cutting skin and infant delivery between the two groups (2.24 ± 0.08 vs. 2.18 ± 0.13, P > 0.05). Additionally, the Apgar score at 1 min after birth was higher in the training group compared to the untrained group (7.29 ± 2.38 vs. 6.04 ± 1.46, P < 0.05).ConclusionsThe DDI for emergency caesarean section procedures can be significantly shortened, and neonatal Apgar scores at 1 min improved by implementing in situ simulation training for emergency caesarean section in obstetric rapid response teams. In situ simulation training is an effective tool for training in emergency caesarean section procedures and is worth promoting.

Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report

BackgroundRabies continues to pose significant public health challenges in many developing countries including Bhutan. A probable case of rabies was admitted to our hospital and its reporting led to the uncovering of an outbreak in domestic and wild animals. We discuss the challenges in the diagnosis and management of rabies in a resource-limited setting.Case presentationA 35-year-old male presented with intermittent fever, bilateral lower limb weakness that was rapidly progressive, urinary incontinence with episodes of palpitations and sweating. He had sustained a Category III bite on the right lower thigh with four bite marks, inflicted by a stray dog. He had received post-exposure prophylaxis with intra-dermal anti-rabies vaccine. On initial examination, the patient was in distress but cooperative for the interview. He had pulse rate ranging from 60 to 100/min with episodes of diaphoresis and palpitations, but with normal capillary blood glucose. In the lower limb, the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T10 level. He had hyperaesthesia below T8, hydrophobia, aerophobia and photophobia. He had multiple spontaneous fasciculations in both the thighs and right deltoid and these later involved the intercostal muscles, neck and face muscles. He had altered sensorium and desaturation for which he required mechanical ventilation. Polymerase chain reaction for rabies virus was negative in cerebrospinal fluid and saliva. Rabies virus neutralizing antibody was negative in cerebrospinal fluid but had high titres in the serum. He received Human Rabies Immunoglobulin after admission. He was managed in the intensive care unit and died 23 days later. After this case was notified, a rapid response team was deployed in the field, and uncovered rabies outbreak in animals in the locality.ConclusionsThis case called for a serious evaluation of the country’s efforts in achieving zero rabies deaths by 2030. The management of this case identified several critical areas of context-specific interventions in Bhutan. There is also an urgent need to improve diagnostic capabilities at the national reference laboratory and enhance the technical competencies of healthcare workers in the management of dog bite cases.Graphical

Two consecutive outbreaks caused by chlorhexidine mouthwash contaminated with Burkholderia contaminans in a two-hospital tertiary care system

Hospital outbreaks caused by Burkholderia spp. have been linked to contamination of several medical solutions and products and are frequently associated with delayed detection and high mortality. To describe the management of two consecutive Burkholderia contaminans outbreaks caused by contaminated mouthwash of different brands during the COVID-19 pandemic. This was a retrospective cohort study of all patients involved in two outbreaks caused by B.contaminans detected in 2021 and 2022. The investigation was initiated after a cluster of positive respiratory specimens, followed by retrospective and prospective case-finding. A total of 69 patients were affected, 47 in 2021 and 22 in 2022. The majority of affected patients had positive respiratory specimens (85.5%); 55.1% of cases had COVID-19, and 72.5% had multidrug-resistant organisms. Almost all (97.1%) patients required ventilation and 42.0% died. Seventeen percent of cases in the first outbreak were deemed to have been acquired by patient-to-patient transmission, whereas all of the cases in the second outbreak were infected directly from using mouthwash. The experience gained from the first outbreak and the formation of a multidisciplinary Infection Control Rapid Response Team resulted in more rapid recognition and control of the second outbreak. Multivariate analysis showed that older age, intensive care unit admission, and COVID-19 infection were independent predictors of mortality. Burkholderia outbreaks at the time of COVID-19 were associated with high mortality. Rapid detection and response by a dedicated experienced team (as in the second outbreak) can reduce mortality and prevent superimposed cross-transmission between patients.

Eliciting community‐preferred policy alternatives for achieving workable coexistence in a human‐dominated landscape: Insights from Chitwan National Park, Nepal

AbstractHuman‐wildlife conflict is a global issue that poses a major threat to biodiversity conservation and sustainable development. Wildlife adapted to human‐modified landscapes in developing countries can threaten the safety and livelihood of local communities. In such landscapes, where people and wildlife compete for resources, community involvement is promoted to achieve workable coexistence. We used a choice experiment methodology approach to identify community‐preferred policy alternatives in Chitwan National Park in south‐central Nepal. The results indicated that conflicts between the local community and wildlife are on the rise, crop damage being the highest form of damage and most perceived compensation and fencing as conflict‐mitigation tools. The choice experiment showed that residents have a positive preference for enhancing livelihood diversification skills, cultivating buffer crops, promoting alternative livelihoods, and strengthening rapid response teams. We identified concerned mitigators who are younger age group, encountered and concurred that HWC is increasing, and agreed that fencing and compensation are conflict‐mitigation tools. We designed scenario planning using community‐preferred policy alternatives to assist the park management. This is the first‐choice experiment study to design an evaluation framework under community resilience perspectives to achieve workable coexistence. Our study has potential implications for promoting coexistence in a human‐dominated landscape.

EP02.32: Integrated healthcare model for obstetric complications: transport brigades and rapid response teams

EP02.32: Integrated healthcare model for obstetric complications: transport brigades and rapid response teams

The cost of public health interventions to respond to the 10th Ebola outbreak in the Democratic Republic of the Congo

The 10th Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) drew substantial attention from the international community, which in turn invested more than US$1 billion...

Socialization on Saving Lives with Disaster Mitigation in Poko Village, Jambon District, Ponorogo Regency

Natural disasters cause massive losses and damage and have quite a large impact both materially and non-materially and can cause changes to the socio-economic conditions of the people as the affected parties. The lack of public knowledge of actions and disaster management through mitigation that occurred in Poko Village, Jambon District caused natural disasters that occurred to have an impact. The purpose of this article is to analyze the effectiveness of outreach in increasing community awareness and preparedness related to potential disasters in the Poko Village area, Jambon District. This research method uses a qualitative approach. The results showed that the socialization program had succeeded in increasing community awareness regarding disaster risks in Poko Village. Through the dissemination of clear information and the active participation of the community in evacuation simulations and mitigation exercises, the level of disaster preparedness has increased significantly. Knowledge of disaster mitigation measures, such as creating evacuation routes and participation in rapid response teams, has also seen a marked increase.

Rapid response team activation prior to in-hospital cardiac arrest: Areas for improvements based on a national cohort study

IntroductionRapid response teams (RRTs) are designed to improve the “chain of prevention” of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs. MethodsA nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs. ResultsIn all, 12,915 IHCA patients were included. RRT-reviewed patients (n = 2,058) had a lower unadjusted 30-day survival (25% vs 33%, p < 0.001), a propensity score based Odds ratio for 30-day survival of 0.92 (95% Confidence interval 0.90–0.94, p < 0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p < 0.001). In the subgroup (n = 82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p < 0.001). ConclusionIHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.

A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques.

Currently, many hospitals use vital signs-based criteria such as modified early warning score (MEWS) and national early warning score (NEWS) to classify high-risk patients for cardiac arrest, but there are limitations in selecting high-risk patients with a possibility of cardiac arrest. The purpose of this study is to develop a cardiac arrest classification model to identify patients at high risk of cardiac arrest based on the patient family and past history, and blood test results after hospitalization, rather than vital signs. This study used electronic medical record (EMR) data from A university hospital, and patients in the high-risk group for cardiac arrest were defined as those who underwent cardio-pulmonary resuscitation (CPR) after cardiac arrest. Considering the use of the rapid response team of A university hospital, patients hospitalized in intensive care units (ICU), emergency medicine departments, psychiatric departments, pediatric departments, cardiology departments, and palliative care wards were excluded. This study included 325,534 patients, of which 3291 low-risk and 382 high-risk patients were selected for study. Data were split into training and validation data sets and univariate analysis was performed for 13 candidate risk factors. Then, multivariate analysis was performed using a bivariate logistic regression model, and an optimal model was selected using simulation analysis. In the training data set, it was calculated as sensitivity 75.25%, precision 21.59%, specificity 66.89%, accuracy 67.79%, F1 score 33.56, area under curve (AUC) 71.1 (95% confidence interval [CI] = 68.9-73.1 P value=<.001). In the validation data set, sensitivity 73.37%, precision 25.81%, specificity 75.03%, accuracy 74.86%, F1 score 38.19, AUC 74.2 (95% CI = 72.1-76.2, P value=<.001) were calculated. A model for classifying the high-risk group of cardiac arrest should be developed from various perspectives. In the future, in order to classify patients with high risk of cardiac arrest, a prospective study on the combined use of the model developed by this study and NEWS or MEWS should be conducted.

An analysis of a new rapid difficult airway response team in a vertically built children's hospital.

Intrahospital transport is associated with adverse events. This challenge is amplified during airway management. Although difficult airway response teams have been described, little attention has been paid to patient transport during difficult airway management versus the alternative of managing patient airways without moving the patient. This is especially needed in a 22-floor vertical hospital. Development of a rapid difficult airway response team and an associated difficult airway cart will allow for the ability to manage difficult airways in the patient's primary location. A retrospective chart review of all rapid difficult airway response activations from December 18, 2019 to December 31, 2021 was performed to determine the number of airways secured in the patient's primary location (primary outcome). Secondary outcomes included length of time until airway securement, airway device used, number of attempts, complications, use of front of neck access, and mortality. There were 96 rapid difficult airway response activations in a 2-year period, with 18 activations deemed inappropriate. Of the 78 indicated rapid difficult airway response deployments, all activations resulted in a secure airway, and 76 (97.4%) of cases had an airway secured in the patient's primary location. The mean time to airway securement was 17.1 min (standard deviation 18.8 min). The most common methods of airway securement were direct laryngoscopy (42.3%, 33/78) and video laryngoscopy (29.5%, 23/78). The mean number of attempts by the rapid difficult airway response team was 1.4. There were no documented cases requiring front of neck access. The Cormack-Lehane airway grade at time of intubation was I-II in 83.3% (65/78) of activations. Rapid difficult airway response activation resulted in 16 cases of cardiac arrest and 4 patient deaths within 48 h. A rapid difficult airway response team allows a large majority of patients' airways to be managed and secured in the patient's primary hospital location. Future directions include reducing time to airway securement and identifying factors associated with cardiac arrest.

Predictors of Escalation to Intensive Care Unit Level of Care Among Admissions for Alcohol Withdrawal.

According to the 2019 National Survey on Drug Use and Health, 14.5 million people ages 12 and older had alcohol abuse disorder. Alcohol withdrawal syndrome (AWS) can be defined as a collection of physical symptoms experienced due to abrupt cessation of alcohol after long-term dependence. In instances where regular inpatient management fails to control AWS symptoms, patients are shifted to intensive care units (ICUs) for closer monitoring and prevention of life-threatening complications like withdrawal seizures and delirium tremens (DTs), labeled as severe alcohol withdrawal syndrome (SAWS). Although this represents a significant healthcare burden, minimal studies have been conducted to determine objective predictors. In this study, we aim to determine the effect of patient demographics, socio-economic status, biochemical parameters, and clinical factors on the need for escalation to ICU level of care among admissions for AWS. Our study showed that factors such as a history of DTs or alcohol-related seizures, the initial protocol of management, degree of reported alcohol usage, activation of rapid response teams, mean corpuscular value, alcohol level on admission, highest Clinical Institute Withdrawal Assessment Alcohol Revised (CIWA-Ar) scored during the hospital stay, and the total amount of sedatives used were significantly associated with escalation to ICU level of care. Clinicians must use these objective parameters to identify high-risk patients and intervene early. We encourage further studies to establish a scoring algorithm incorporating biochemical parameters to tailor management algorithms that might better suit high-risk patients.

The application of rapid response team in category 1 emergency caesarean section teaching for OBGYN residents in the delivery room.

Category 1 cesarean section (CS) can be a life-saving procedure when there is immediate threat to the life of the woman or fetus. However, category 1 CS is a challenge for obstetrics and gynecology residents, and it is necessary to establish an effective and straightforward teaching strategy. This study aimed to evaluate the efficiency of rapid response team (RRT) on category 1 CS teaching for obstetrics and gynecology residents in the delivery room. A total of 142 residents who underwent standardized residency training programs in the delivery room were divided into a RRT teaching group and a traditional response (TR) teaching group. In the RRT teaching group, Category 1 emergency CS teaching was started and explored by rapid response team. The training included both theoretical and practical components. After the training, decision-to-delivery interval (DDI), neonatal Apgar score, operation time and rate of postpartum hemorrhage were compared. A questionnaire on the subjective assessment of various aspects of the program was conducted at the end of the training period. The DDI in minutes in the RRT teaching group (n = 72) was significantly shorter than that of the TR teaching group (n = 70) (11.83 ± 4.16 vs 13.56 ± 5.47, P = .0364). The score of satisfaction from residents in the RRT teaching group was significantly higher than that of the TR group [7 (6, 9) vs 9 (7, 10), P = .0154]. Compared with the TR teaching group, more residents thought their clinical skills have been improved (94.29% vs 100%, P = .0396) and willing to recommend their training method to others (91.43% vs 100%, P = .0399) in the RRT teaching group. However, no significant differences were observed in the incidence of postpartum hemorrhage between the 2 groups. RRT teaching is beneficial in the standardized training and teaching of residents in the delivery room. It improves the DDI of category 1 emergency cesarean section and the degree of satisfaction.