EDITORIAL N-HOSPITAL CARDIAC ARREST (IHCA) IS OFTEN rithms for predicting mortality. Respiratory rate deter- the end result of progressive clinical deterio- mination, for example, is notoriously error prone in ration caused by reversible underlying causes the hospital, while assessment of mental status is such as sepsis and respiratory failure, which highly variable. However, in a prospective study of I have better survival the earlier they are abnormal physiology on the general floors, abnormali- treated. It therefore follows that a rapid response sys- ties in each of these 2 parameters were several times tem (RRS) designed to identify early signs of clinical more predictive of death than any other abnormal deterioration and activate a specialized team of clini- clinical findings. cians should decrease hospital mortality. This idea is Given the limited quality of current physiologic so intuitive that it might be reasonable to disregard data, it is not surprising that attempts to model mor- some evidence to the contrary, as the Joint Commis- tality in these patients for the purposes of optimizing sion did with its 2008 National Patient Safety Goals, RRT calling criteria have yielded scoring systems with mandating such a system in US hospitals. only moderate predictive abilities.
JAMA Internal Medicine – American Medical Association
Published: Jan 11, 2010