Tee Augustine, Choo Bryan Peide, Gokhale Roshni Sadashiv, Wang Xiqin, Mansor Mashithah, Oh Hong Choon, Jones Daryl
Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
Health Services Research, Changi General Hospital, Singapore.
Resusc Plus. 2023 Sep 1;16:100461. doi: 10.1016/j.resplu.2023.100461. eCollection 2023 Dec.
Rapid response systems (RRS) are present in many acute hospitals in western nations but are not widely adopted in Asia. The influence of healthcare culture and the effect of implementing an RRS over time are infrequently reported. We describe the introduction a RRS into a Singaporean hospital and the barriers encountered. The efferent limb activation rates, cardiac arrest rates and unplanned intensive care unit (ICU) admissions are trended over eleven years.
We conducted a retrospective observational study using prospectively collected data derived from administrative and Medical Emergency Team (MET) databases.
The RRS used a MET with a single parameter track and trigger and physician led efferent limb. Barriers encountered included clinical leadership buy-in, assembling and equipping the efferent team, maintaining a non-punitive mindset, improving accessibility to MET and communicating the impact of the MET. Over an 11-year period with 488,252 hospital admissions, MET activation rates increased from 1.6/1000 admissions (2009) to 14.1/1000 admissions (2019). Code blue activations and unplanned ICU admission rates decreased from 2.9 to 1.7 and from 8.8 to 2.0/1000 admissions, respectively over the 11 years. There were associations between increasing MET activation rate and reduction in code blue activations (p = 0.013) and unplanned medical ICU admission rates (p = 0.001).
Implementing, sustaining and continued improvement of an RRS in Singapore is possible despite challenges encountered. With increasing activation rates over a decade, there were reductions in cardiac arrest rates and unplanned medical ICU admissions.
快速反应系统（RRS）在西方国家的许多急症医院中都有应用，但在亚洲尚未广泛采用。医疗文化的影响以及随着时间推移实施RRS的效果鲜有报道。我们描述了在一家新加坡医院引入RRS的情况以及遇到的障碍。并对十一年来传出肢体激活率、心脏骤停率和非计划重症监护病房（ICU）入住率进行了趋势分析。
我们进行了一项回顾性观察研究，使用从行政和医疗急救团队（MET）数据库中前瞻性收集的数据。
该RRS采用了一个具有单一参数追踪和触发功能的MET，且传出肢体由医生主导。遇到的障碍包括临床领导层的支持、组建和配备传出团队、保持非惩罚性心态、提高MET的可及性以及传达MET的影响。在11年期间，共有488,252例住院病例，MET激活率从2009年的1.6/1000例住院病例增加到2019年的14.1/1000例住院病例。在这11年中，蓝色代码激活率和非计划ICU入住率分别从2.9降至1.7以及从8.8降至2.0/1000例住院病例。MET激活率的增加与蓝色代码激活率的降低（p = 0.013）和非计划医疗ICU入住率的降低（p = 0.001）之间存在关联。
尽管遇到了挑战，但在新加坡实施、维持和持续改进RRS是可行的。随着十年来激活率的增加，心脏骤停率和非计划医疗ICU入住率有所下降。
