Aoyama Takeshi, Tsuneyoshi Isao, Otake Takanao, Ouchi Kazuo, Kawase Yuta, Arai Masayasu, Shibata Naoaki, Fujiwara Shinsuke, Fujitani Shigeki
Department of Emergency and Critical Care Medicine, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu-cyou, Miyazaki City, Miyazaki 880-0017, Japan.
Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cyou, Miyazaki City, Miyazaki 889-1692, Japan.
Resusc Plus. 2021 Jan 11;5:100065. doi: 10.1016/j.resplu.2020.100065. eCollection 2021 Mar.
The rapid response system (RRS) has become well known as a patient safety system to reduce adverse in-patient events, and it is also required to respond to patients in the outpatient department. However, only few studies have reported on the RRS in the outpatient department. We analysed the current status of the RRS in the outpatient department based on a multicentre online registry in Japan.
This is a prospective multicentre observational study. Among the cases registered in the RRS online registry from January 2014 to March 2018, cases from the outpatient department, consisting of the general outpatient department, radiation department, dialysis department, endoscope department, rehabilitation department, and the surrounding areas were eligible for this study.
A total of 6784 cases were registered, and 1022 cases were included. The main reason for activation was altered mental status (39.1%). Incomplete vital sign recording at activation was 67.0%, whereas body temperature (57.0%) and respiratory rate (36.4%) deficits were frequent. The most common intervention during RRS activation was fluid bolus (38.2%) and oxygen supplementation (30.9%). The general outpatient department accounted for nearly half of the activation locations. The 30-day mortality rate for the location was significantly higher in the dialysis department (P < 0.001).
We have reported the first study of RRSs in outpatient departments at multicentre facilities in Japan. The difference in the mortality rate for the location was clarified. Future tasks will involve clarifying the RRS outcome indicators in the outpatient department and examining the effectiveness thereof.
快速反应系统（RRS）作为一种减少住院患者不良事件的患者安全系统已广为人知，同时也需要应用于门诊部患者。然而，仅有少数研究报道过门诊部的快速反应系统。我们基于日本多中心在线登记系统分析了门诊部快速反应系统的现状。
这是一项前瞻性多中心观察性研究。在2014年1月至2018年3月登记在快速反应系统在线登记处的病例中，来自门诊部（包括普通门诊部、放射科、透析科、内镜科、康复科及其周边区域）的病例符合本研究要求。
共登记6784例病例，纳入1022例。激活的主要原因是精神状态改变（39.1%）。激活时生命体征记录不完整的比例为67.0%，其中体温（57.0%）和呼吸频率（36.4%）记录缺失较为常见。快速反应系统激活期间最常见的干预措施是静脉推注液体（38.2%）和吸氧（30.9%）。普通门诊部的激活地点占近一半。透析科该地点的30天死亡率显著更高（P<0.001）。
我们报道了日本多中心医疗机构门诊部快速反应系统的首次研究。明确了该地点死亡率的差异。未来的任务将包括明确门诊部快速反应系统的结果指标并检验其有效性。
