Impact of increased calls to rapid response systems on unplanned ICU admission

Am J Emerg Med. 2020 Jul;38(7):1327-1331. doi: 10.1016/j.ajem.2019.10.028. Epub 2019 Nov 18.


Background: Whether hospital bed number and rapid response system (RRS) call rate is associated with the clinical outcomes of patients who have RRS activations is unknown. We test a hypothesis that hospital volume and RRS call rates are associated with the clinical outcomes of patients with RRSs.

Methods: This is a retrospective chart analysis of an existing dataset associated with In-Hospital Emergency Registry in Japan. In the present study, 4818 patients in 24 hospitals from April 2014 to March 2018 were analyzed. Primary outcome variable was an unplanned intensive care unit (ICU) admission after RRS activation.

Results: In the primary analysis of the study using a multivariate analysis adjusting potential confounding factors, higher RRS call rate was significantly associated with decreased unplanned ICU admissions (P < 0.0001, Odds ratio [OR] 0.95, 95% confidence interval [CI] 0.92-0.98), but there was no significant association of hospital volume with unplanned ICU admissions (P = 0.44). In the secondary analysis of the study, there was a non-significant trend of increased cardiac arrest on arrival at the location of the RRS provider at large-volume hospitals (P = 0.084, OR 1.16, 95% CI 0.98-1.38). Large-volume hospitals had a significantly higher 1-month mortality rate (P = 0.0040, OR 1.10, 95% CI 1.03-1.18).

Conclusion: Hospitals with increased RRS call rates had significantly decreased unplanned ICU admission in patients who had RRS activations. Patients who had RRS activations at large-volume hospitals had an increased 1-month mortality rate.

Keywords: Call rate; Critical care; Hospital size; Rapid response system; Unexpected adverse event; Unplanned ICU admission.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Critical Care
  • Critical Care Outcomes*
  • Female
  • Heart Arrest / therapy
  • Hospital Bed Capacity / statistics & numerical data*
  • Hospital Mortality*
  • Hospital Rapid Response Team / statistics & numerical data*
  • Hospitalization / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Japan
  • Male
  • Middle Aged
  • Mortality
  • Multivariate Analysis
  • Retrospective Studies
  • Wounds and Injuries / therapy