STATISTICAL ANALYSIS OF IN-HOSPITAL EMERGENCY PATIENTS IN SHOWA UNIVERSITY HOSPITAL AND SHOWA UNIVERSITY EAST HOSPITAL

Abstract

Ensuring the medical safety of patients and infection control is the backbone of risk management in hospitals. Furthermore, The Japan Council for Quality Health Care requires hospitals to have a medical safety system. In recent years, efforts geared toward preventing sudden deterioration in the hospital ［rapid response system （RRS）］ have attracted attention, in addition to the actual dealing with sudden deterioration in the hospital. There are several medical safety systems in Showa University Hospital and Showa University East Hospital. In this study, we analyzed cases of sudden nosocomial deterioration （especially the Code Blue system which has the highest urgency） to characterize cases in which sudden deterioration occurred before RRS was introduced into Showa University Hospital and Showa University East Hospital. This analysis included 129 cases of Code Blue requests during the four years from April 2014 to March 2018. Of the cases in which sudden nosocomial deterioration occurred, 41.0% involved hospitalized patients, whereas the remaining cases involved outpatients, patients’ family members, and hospital staff. The mean age of the patients was 63.6 years. Cardiopulmonary arrest occurred in 26.4%; the mean age of these patients was 71.2 years, and 82.4% of these patients were hospitalized. The incidence was 4.36 per 1,000 hospitalized patients. Of the patients with cardiopulmonary arrest, 44% were successfully resuscitated; however, only neurological function recovered to the level before the sudden deterioration in 20.6% of the patients. A shorter duration of time to return of spontaneous circulation was associated with a better neurological function prognosis. The survival rate and improvement of neurological function prognosis were not sufficient even in cases of in-hospital cardiopulmonary arrest. These findings indicate that the key to ensure medical safety in hospitals is to introduce a functional system （RRS） effective for preventing sudden deterioration to cardiopulmonary arrest or in-hospital cardiopulmonary arrest.