The effectiveness of a standardised rapid response system on the reduction of cardiopulmonary arrests and other adverse events among emergency surgical admissions

Lixin Ou; Jack Chen; Ken Hillman; Arthas Flabouris; Michael Parr; Malcolm Green

doi:10.1016/j.resuscitation.2020.01.021

The effectiveness of a standardised rapid response system on the reduction of cardiopulmonary arrests and other adverse events among emergency surgical admissions

Resuscitation. 2020 May:150:162-169. doi: 10.1016/j.resuscitation.2020.01.021. Epub 2020 Jan 28.

Authors

Lixin Ou¹, Jack Chen², Ken Hillman², Arthas Flabouris³, Michael Parr⁴, Malcolm Green⁵

Affiliations

¹ Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia. Electronic address: lixin.ou@unsw.edu.au.
² Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
³ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
⁴ Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Intensive Care Unit, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia; Intensive Care Unit, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia.
⁵ Clinical Excellence Commission, New South Wales, Australia.

PMID: 32004664
DOI: 10.1016/j.resuscitation.2020.01.021

Abstract

Aim: A standardised rapid response system (RRS), called the "Between-the-Flags" (BTF) program, was implemented across a large health jurisdiction in Australia in 2010. The impact of RRS on emergency surgical admissions is unknown.

Methods: We linked the NSW Admitted Patient Data Collection (APDC) and the NSW Registry of Births, Deaths, and Marriages. We used a propensity score-based inverse-probability-weighting adjustment to estimated average treatment effects among treated subjects (prior-RRS hospitals vs prior-non-RRS hospitals) before the BTF implementation (2007-2008) and after (2010-2013).

Results: Before BTF, prior-RRS hospitals had a lower rate of in hospital cardiopulmonary arrests (IHCA) (4.7 vs 7.8 per 1000 admissions, P < 0.001), a lower rate of IHCA related deaths (3.0 vs 4.4 per 1000 admissions, P = 0.03) compared with patients in prior-non-RRS hospitals. There were no significant differences in overall in-hospital mortality and 30-day mortality between the two cohorts. After BTF, there were no significant differences for IHCA (4.8 vs 5.5 per 1000 admissions, P = 0.081) and related death rates (2.4 vs 2.3 per 1000 admissions, P = 0.678) between the two cohorts. Hospital mortality, 30-day mortality improved across both prior-RRS and prior-non-RRS hospitals following the BTF implementation.

Conclusion: BTF program was associated with a significant reduction in IHCA and IHCA deaths for emergency surgical patients in prior-non-RRS hospitals but not in the prior-RRS hospitals. The overall hospital and 30-day mortality improved in both cohorts after BTF.

Keywords: Cardio-pulmonary arrest; Emergency; Mortality; Rapid response system; Surgical.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Heart Arrest*
Hospital Mortality
Hospitalization
Humans
Registries